Recommendations for Biomarkers in HF Biomarker, Application Setting COR LOE References Natriuretic peptides Diagnosis or exclusion of HF Ambulatory, Acute I A 64 70,92 98 Prognosis of HF Ambulatory, Acute I A 69,71 76,96,99 106 Achieve GDMT Ambulatory IIa B 77 84 Guidance for acutely decompensated HF therapy Acute IIb C 107,108 Biomarkers of myocardial injury Additive risk stratification Acute, Ambulatory I A 85 88,96,101,104 115 Biomarkers of myocardial fibrosis Additive risk stratification Ambulatory IIb B 89 91 Acute IIb A 96,101,104,106 108,110,112 115 COR indicates Class of Recommendation; GDMT, guideline-directed medical therapy; HF, heart failure; and LOE, Level of Evidence. Table 7. 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. 