Using Stress Testing and Advanced Imaging for Patients With Known SIHD Who Require Noninvasive Testing for Risk Assessment Test Exercise Status ECG Interpretable COR LOE References Additional Considerations Able Unable Yes No Patients able to exercise* Exercise ECG X X I B (106 110, 112 114, 132 134) Exercise with nuclear MPI or Echo X X I B (7, 111, 264 266, 270, 299, 300) Abnormalities other than LBBB or ventricular pacing Exercise with nuclear MPI or Echo X X IIa B (271 279) Pharmacological stress CMR X X IIa B (279 284) CCTA X X IIb B (285, 286) Pharmacological stress imaging (nuclear MPI, Echo, CMR) or CCTA X X III: No Benefit C N/A Patients unable to exercise Pharmacological stress with nuclear MPI or Echo Pharmacological stress CMR X Any IIa B (280 284, 291) CCTA X Any IIa C (286) Without prior stress test Regardless of patient s ability to exercise Pharmacological stress with nuclear MPI or Echo Any X I B (287 290, 292) LBBB present Exercise/pharmacological stress with nuclear MPI, Echo, or CMR Any Any I B (266, 278, 293, 294) Known coronary stenosis of unclear physiological significance being considered for revascularization CCTA Any Any IIa C N/A Indeterminate result from functional testing CCTA Any Any IIb C N/A Unable to undergo stress imaging or as alternative to coronary catheterization when functional testing indicates moderate to high risk and angiographic coronary anatomy is unknown Requests to perform multiple cardiac imaging or stress studies at the same time Any Any III: No Benefit C N/A *Patients are candidates for exercise testing if they are capable of performing at least moderate physical functioning (ie, moderate household, yard, or recreational work and most activities of daily living) and have no disabling comorbidity. Patients should be able to achieve 85% of age-predicted maximum heart rate. 