ABC | Volume 113, Nº1, July 2019

Statement Position Statement on Indications of Echocardiography in Adults – 2019 Arq Bras Cardiol. 2019; 113(1):135-181 Content 1. Introduction ......................................................................................138 2. Evaluation of Heart Function and Structure ................................139 2.1. Left Ventricular Systolic Function ......................................................139 2.2. Left Ventricular Dyastolic Function ....................................................140 2.3. Cardiomyopathies .............................................................................140 2.3.1. Dilated Cardiomyopathy ..............................................................141 2.3.2. Chagasic Dilated Cardiomyopathy ...............................................141 2.3.3. Cardiac Resynchronization Therapy and Pacemaker Optimization ...........................................................................................141 2.3.4. Assessment after Heart Transplantation .......................................142 2.3.5. Monitoring of Cardiac Function During Chemotherapy with Cardiotoxic Drugs ...................................................................................143 2.3.6. Hypertrophic Cardiomyopathy .....................................................145 2.3.7. Restrictive Cardiomyopathies .......................................................145 2.3.8. Arrhythmogenic Cardiomyopathy (Right Ventricle Arrhythmogenic Dysplasia) ...............................................................................................146 2.3.9. Non-compaction Cardiomyopathy ...............................................147 2.4. Arterial Hypertension and Myocardial Hypertrophy ...........................148 2.5. Athletes ............................................................................................149 3. Heart Murmurs, Valvular Heart Disease, Valvular Prostheses and Endocarditis ..................................................................................150 3.1. Heart Murmurs .................................................................................150 3.2. Native Valves ....................................................................................150 3.2.1. Mitral Regurgitation ......................................................................150 3.2.2. Mitral Stenosis ..............................................................................151 3.2.3. Aortic Stenosis ..............................................................................153 3.2.4. Aortic Regurgitation ......................................................................154 3.2.5. Tricuspid Valvopathy .....................................................................154 3.2.6. Pulmonary Valvopathy ..................................................................154 3.2.7. Associated Valvar Lesions .............................................................155 3.3. Valve Prostheses ...............................................................................158 3.4. Infective Endocarditis ........................................................................160 4. Hypertension and Pulmonary Thromboembolism .....................160 5. Coronary Artery Disease ................................................................161 5.1. Introduction ......................................................................................161 5.2. Acute Coronary Syndrome ................................................................161 5.2.1. Transthoracic Echocardiography ...................................................161 5.2.2. Stress Echocardiography ...............................................................162 5.2.3. Contrast Echocardiography ...........................................................162 5.3. Chronic Coronary Artery Disease .......................................................163 5.3.1. Transthoracic Echocardiography ...................................................163 5.3.2. Stress Echocardiography ...............................................................163 5.3.3. Contrast Echocardiography ...........................................................163 6. Evaluation of Emboligenic Sources and Cardioembolic Diseases ................................................................................................164 7. Atrial Fibrillation ..............................................................................166 8. Heart Tumors and Masses .............................................................166 9. Pericardial Diseases .......................................................................167 10. Systemic Diseases ........................................................................168 10.1. Introduction ....................................................................................168 10.2. Chronic Renal Failure ......................................................................168 10.3. Amyloidosis ....................................................................................168 10.4. Sarcoidosis .....................................................................................168 10.5. Neoplasms .....................................................................................168 10.6. Autoimmune Diseases ....................................................................168 11. Diseases of The Aorta, Pulmonary Artery and Veins ..............168 11.1. Aorta ..............................................................................................168 11.2. Pulmonary Artery ...........................................................................169 11.3. Veins ...............................................................................................169 12. Intraoperative Echocardiography in Cardiac and Non-Cardiac Surgeries ...............................................................................................169 12.1. Introduction ....................................................................................169 12.2. Modalities of Intraoperative Echocardiography ...............................169 12.3. Recommendations in Cardiac and Thoracic Aorta Surgery .............169 12.4. Recommendations in Non-Cardiac Surgeries ..................................170 13. Echocardiography in Percutaneous Interventions ...................170 13.1. Introduction ....................................................................................170 13.2. Follow-up of Interventions in Congenital Heart Diseases .................170 13.3. Electrophysiology Procedures .........................................................171 13.4. Alcoholic Ablation in Hypertrophic Cardiomyopathy ........................171 13.5. Left Atrial Appendage Occlusion .....................................................171 13.6. Treatment of Heart Valves ..............................................................171 13.7. Treatment of Prosthetic Dysfunction ...............................................171 References ............................................................................................172 1. Introduction In accordance with the “Standards for the Elaboration of Guidelines, Positions and Normations” sanctioned by the Brazilian Society of Cardiology, this document was written to update the “Echocardiography Indication Guidelines” of 2009. The new document is not intended to be a comprehensive review of echocardiography, but rather an indispensable basic guide to support the rational clinical decision-making of the physician requesting the exam for adult patients. Although it considers the recent technological advances of echocardiography, its purpose is not to describe in detail echocardiography methods, but to summarize in a clear and concise way the main situations in which echocardiography brings benefit to the diagnosis and/or therapeutic orientation of the individual. This manuscript chose to highlight the class of recommendation, as described below: ● Class I: conditions for which there is conclusive evidence or, in the absence thereof, general agreement that the examination procedure is useful and safe. ● Class II: conditions for which there is conflicting evidence and/or divergence of opinion on the utility and/or safety of the examination. ● Class IIa: evidence or opinions favorable to the examination. Most experts approve. ● Class IIb: utility and/or safety less well established, with divergent opinions. ● Class III: conditions for which there is evidence or consensus that the examination is not useful and, in some cases, may even be harmful. In addition, the level of evidence was also described, as follows: ● A: several concordant randomized clinical trials or robust meta-analyses; ● B: less robust meta-analysis data or single randomized clinical study or observational studies; ● C: expert opinion. 138