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Circulation. 2021;144:e368–e454. DOI: 10.1161/CIR.0000000000001029 November 30, 2021 e427 CLINICAL STATEMENTS AND GUIDELINES

15 Einstein AJ, Berman DS, Min JK, et al. Patient-centered imaging: shared

decision making for cardiac imaging procedures with exposure to ionizing radiation. J Am Coll Cardiol. 2014;63:1480–1489. 16.	 Einstein AJ. Effects of radiation exposure from cardiac imaging: how good are the data? J Am Coll Cardiol. 2012;59:553–565. 17.	 Fazel R, Gerber TC, Balter S, et al. Approaches to enhancing radiation safety

in cardiovascular imaging: a scientific statement from the American Heart Association. Circulation. 2014;130:1730–1748.

3.2.4 Cardiovascular Magnetic Resonance Imaging

1 Henzlova MJ, Duvall WL, Einstein AJ, et al. ASNC imaging guidelines for

SPECT nuclear cardiology procedures: stress, protocols, and tracers. J Nucl Cardiol. 2016;23:606–639. 2.	 Senior R, Becher H, Monaghan M, et al. Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography. Eur J Echocardiogr. 2009;10:194–212. 3.	 Patil HR, Main M. Revisiting the safety profile of echocardiography contrast agents. Available at: https://www.acc.org/latest-in-cardiology/articles/2016/06/23/08/23/revisiting-the-safety-profile-of-echocardiography-contrast-agents. Accessed August 16, 2020. 4.	 Porter TR, Abdelmoneim S, Belcik JT, et al. Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27:797–810. 5.	 Pellikka PA, Arruda-Olson A, Chaudhry FA, et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography. J Am Soc Echocardiogr. 2020;33:1–41.e8. 6.	 Kramer CM, Barkhausen J, Bucciarelli-Ducci C, et al. Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. J Cardiovasc Magn Reson. 2020;22:17. 7.	 Narula J, Chandrashekhar Y, Ahmadi A, et al. SCCT 2021 Expert consensus document on coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2021;15:192–217. 8.	 Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA Guidelines for exercise testing. a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) J Am Coll Cardiol. 1997;30:260–311. 9.	 Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128:873–934. 10.	 Henzlova MJ, Cerqueira MD, Mahmarian JJ, et al. Stress protocols and tracers. J Nucl Cardiol. 2006;13:e80–e90. 11.	 SNM Procedure Guideline for General Imaging 6.0 Available at: https:// s3.amazonaws.com/rdcms-snmmi/files/production/public/docs/General_ Imaging_Version_6.0.pdf. Accessed July 26, 2021. 12.	 Committee on Obstetric Practice. Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130:e210–e216. 13.	 Ashwath M. Safety of CMR During Pregnancy and Lactation. Available at: https://scmr.org/page/Pregnancy. Accessed November 9, 2020. 14.	 ACR-SPR practice parameter for imaging pregnant or potentially pregnant

adolescents and women with ionizing radiation. Available at: https://www. acr.org/-/media/ACR/Files/Practice-Parameters/pregnant-pts.pdf. Accessed November 9, 2020.

3.3 Cardiac Testing Considerations for Women

Who Are Pregnant, Postpartum, or of Child- Bearing Age

1 Image Wisely. Available at: https://imagewisely.org. Accessed September

10, 2020. 2.	 Committee on Obstetric Practice. Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130:e210–e216. 3.	 Ray JG, Vermeulen MJ, Bharatha A, et al. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316:952–961. 4.	 Kodzwa R. ACR manual on contrast media: 2018 updates. Radiol Technol.

2019;91:97–100. 5 Expert Panel on MRSKanal E, Barkovich AJ, et al. ACR guidance document

on MR safe practices: 2013 J Magn Reson Imaging. 2013;37:501–530. 6.	 Truong QA, Rinehart S, Abbara S, et al. Coronary computed tomographic

imaging in women: an expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2018;12:451–466.

4 CHOOSING THE RIGHT PATHWAY WITH

PATIENT-CENTRIC ALGORITHMS FOR ACUTE CHEST PAIN

4.1 Patients With Acute Chest Pain and

Suspected ACS (Not Including STEMI)

1 Apple FS, Jesse RL, Newby LK, et al. National academy of clinical biochem-

istry and IFCC committee for standardization of markers of cardiac damage laboratory medicine practice guidelines: analytical issues for biochemical markers of acute coronary syndromes. Circulation. 2007;115:e352–e355. 2.	 Bandstein N, Ljung R, Johansson M, et al. Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol. 2014;63:2569–2578. 3.	 Body R, Burrows G, Carley S, et al. High-sensitivity cardiac troponin t concentrations below the limit of detection to exclude acute myocardial infarction: a prospective evaluation. Clin Chem. 2015;61:983–989. 4.	 Body R, Carley S, McDowell G, et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol. 2011;58:1332–1339. 5.	 Boeddinghaus J, Nestelberger T, Twerenbold R, et al. Direct comparison of 4 very early rule-out strategies for acute myocardial infarction using highsensitivity cardiac troponin I. Circulation. 2017;135:1597–1611. 6.	 Chapman AR, Anand A, Boeddinghaus J, et al. Comparison of the efficacy and safety of early rule-out pathways for acute myocardial infarction. Circulation. 2017;135:1586–1596. 7.	 de Lemos JA, Morrow DA, deFilippi CR. Highly sensitive troponin assays and the cardiology community: a love/hate relationship? Clin Chem. 2011;57:826–829. 8.	 Jaffe AS. Chasing troponin: how low can you go if you can see the rise? J Am Coll Cardiol. 2006;48:1763–1764. 9.	 Jaffe AS, Apple FS, Morrow DA, et al. Being rational about (im)precision: a statement from the Biochemistry Subcommittee of the Joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation Task Force for the Definition of Myocardial Infarction. Clin Chem. 2010;56:941–943. 10.	 Morrow DA, Cannon CP, Jesse RL, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation. 2007;115:e356–e375. 11.	 Mueller C, Giannitsis E, Christ M, et al. Multicenter evaluation of a 0-hour/1hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T. Ann Emerg Med. 2016;68:76–87, e4. 12.	 Odqvist M, Andersson PO, Tygesen H, et al. High-sensitivity troponins and outcomes after myocardial infarction. J Am Coll Cardiol. 2018;71:2616– 2624. 13.	 Peacock WF, Baumann BM, Bruton D, et al. Efficacy of high-sensitivity troponin T in identifying very-low-risk patients with possible acute coronary syndrome. JAMA Cardiol. 2018;3:104–111. 14.	 Reichlin T, Schindler C, Drexler B, et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med. 2012;172:1211–1218. 15.	 Morrow DA. Clinician's guide to early rule-out strategies with high-sensitivity cardiac troponin. Circulation. 2017;135:1612–1616. 16.	 Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138:e618–e651. 17.	 Twerenbold R, Boeddinghaus J, Nestelberger T, et al. Clinical use of highsensitivity cardiac troponin in patients with suspected myocardial infarction. J Am Coll Cardiol. 2017;70:996–1012. 18.	 Januzzi JL Jr, Mahler SA, Christenson RH, et al. Recommendations for institutions transitioning to high-sensitivity troponin testing: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019;73:1059–1077. 19.	 Huis In 't Veld MA, Cullen L, Mahler SA, et al. The fast and the furious:

low-risk chest pain and the rapid rule-out protocol. West J Emerg Med. 2017;18:474–478.

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