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Heartbeat: Highlights from the issue
  1. Catherine M Otto
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}

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In this issue of Heart Dr. Bhattacharyya and colleagues (see page 370) looked at indications for exercise and dobutamine stress echocardiography in a series of 250 consecutive patients. Their findings support Appropriate Use Criteria (AUC) which help separate patients at high versus low risk of subsequent coronary disease events. Inducible ischemia was seen in 45.5% of those with versus only 12.7% in those without an appropriate indication for stress testing (p<0.0001). The authors suggest that AUC can reduce unnecessary stress testing in lower risk patients.

Kaplan–Meier survival curves comparing survival in patients whose indication for stress echocardiography was classified as appropriate, uncertain or inappropriate (p=0.01 for appropriate vs inappropriate; p=0.05 for appropriate vs. uncertain).

In an accompanying editorial, Professors Fonseca and Marwick (see page 357) have a different point of view, reminding us that AUC were developed in the USA using a consensus approach, not based on clinical outcomes. While it is …

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