Assessment of symptoms and clinical function; b. Surveillance for complications of SIHD, including heart failure and arrhythmias; c. Monitoring of cardiac risk factors; and d. Assessment of the adequacy of and adherence to recommended lifestyle changes and medical therapy. 2. Assessment of LVEF and segmental wall motion by echocardiography or radionuclide imaging is recom- mended in patients with new or worsening heart failure or evidence of intervening MI by history or ECG. (Level of Evidence: C) Class IIb 1. Periodic screening for important comorbidities that are prevalent in patients with SIHD, including dia- betes mellitus, depression, and CKD, might be rea- sonable. (Level of Evidence: C) 2. A resting 12-lead ECG at 1-year or longer intervals between studies in patients with stable symptoms might be reasonable. (Level of Evidence: C) Class III: No Benefit 1. Measurement of LV function with a technology such as echocardiography or radionuclide imaging is not recommended for routine periodic reassessment of patients who have not had a change in clinical status or who are at low risk of adverse cardiovascular events.117 (Level of Evidence: C) Standard risk-assessment tools that have been developed from clinical and laboratory evaluation of ambulatory popu- lations with suspected CAD, as discussed in detail in Section 2 of this guideline, include patients who have noncardiac causes of presenting symptoms. However, the performance of these same tools in predicting short-term and long-term risk for coronary mortality and coronary events might vary in patients with known SIHD as compared with patients without known disease who present with chest pain syndromes that might or might not represent angina. 