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This article has been peer reviewed. It is the authors' final version prior to publication in Journal of the American Society of Echocardiography Volume 27, Issue 1, January 2014, Pages 1-7.
The published version is available at DOI: 10.1016/j.echo.2013.08.027. Copyright © Elsevier Inc.


Cardiac imaging is under intense scrutiny as a contributor to health care costs, with multiple initiatives under way to reduce and eliminate inappropriate testing. Appropriate use criteria are valuable guides to selecting imaging studies but until recently have focused on the test rather than the patient. Patient-centered means are needed to define the true value of imaging for patients in specific clinical situations. This article provides a definition of high-value cardiac imaging. A paradigm to judge the efficacy of echocardiography in the absence of randomized controlled trials is presented. Candidate clinical scenarios are proposed in which echocardiography constitutes high-value imaging, as well as stratagems to increase the likelihood that high-value cardiac imaging takes place in those circumstances.

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