Recommendations for Noninvasive Cardiac Imaging Recommendations COR LOE Patients with suspected, acute, or new-onset HF should undergo a chest x-ray I C A 2-dimensional echocardiogram with Doppler should be performed for initial evaluation of HF I C Repeat measurement of EF is useful in patients with HF who have had a significant change in clinical status or received treatment that might affect cardiac function or for consideration of device therapy I C Noninvasive imaging to detect myocardial ischemia and viability is reasonable in HF and CAD IIa C Viability assessment is reasonable before revascularization in HF patients with CAD IIa B (117 121) Radionuclide ventriculography or MRI can be useful to assess LVEF and volume IIa C MRI is reasonable when assessing myocardial infiltration or scar IIa B (122 124) Routine repeat measurement of LV function assessment should not be performed III: No Benefit B (125,126) CAD indicates coronary artery disease; COR, Class of Recommendation; EF, ejection fraction; HF, heart failure; LOE, Level of Evidence; LV, left ventricular; LVEF, left ventricular ejection fraction; and MRI, magnetic resonance imaging. Yancy et al. JACC Vol. 62, No. 16, 2013 2013 ACCF/AHA Heart Failure Guidelines: Executive Summary October 15, 2013:1495 539 2. Viability assessment is reasonable in select situations when planning revascularization in HF patients with CAD (117 121). (Level of Evidence: B) 3. Radionuclide ventriculography or magnetic resonance imaging can be useful to assess left ventricular ejection fraction (LVEF) and volume when echocardiography is inad- equate. (Level of Evidence: C) 4. Magnetic resonance imaging is reasonable when assessing myocardial in ltrative processes or scar burden (122 124). (Level of Evidence: B) CLASS III: NO BENEFIT 1. Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment inter- ventions should not be performed (125,126). 