Measurement of other clinically available tests such as biomarkers of myocardial injury or brosis may be consid- ered for additive risk strati cation in patients with acutely decompensated HF (96,101,104,105,109 115). (Level of Evidence: A) 5.4. Noninvasive Cardiac Imaging See Table 7 for a summary of recommendations from this section. CLASS I 1. Patients with suspected or new-onset HF, or those pre- senting with acute decompensated HF, should undergo a chest x-ray to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient s symptoms. (Level of Evidence: C) 2. A 2-dimensional echocardiogram with Doppler should be performed during initial evaluation of patients presenting with HF to assess ventricular function, size, wall thickness, wall motion, and valve function. (Level of Evidence: C) 3. Repeat measurement of EF and measurement of the severity of structural remodeling are useful to provide information in patients with HF who have had a signi cant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a signi cant effect on cardiac function; or who may be candidates for device therapy. (Level of Evidence: C) CLASS IIa 1. Noninvasive imaging to detect myocardial ischemia and viability is reasonable in patients presenting with de novo HF, who have known coronary artery disease (CAD) and no angina, unless the patient is not eligible for revasculariza- tion of any kind. (Level of Evidence: C) Table 6. 