CPT® Code 0399T

Deleted

1. Indications

The myocardial strain imaging procedure is indicated for a variety of clinical scenarios where assessment of myocardial function is essential. The following conditions and situations warrant the use of this imaging technique:

• Myocardial Dysfunction - To quantify the degree of dysfunction in the heart muscle.
• Myocardial Viability - To assess the viability of myocardial tissue, particularly in patients with ischemic heart disease.
• Acute Allograft Rejection - To detect signs of acute rejection in heart transplant recipients.
• Early Allograft Vasculopathy - To identify early signs of vasculopathy in transplanted hearts.
• Sub-clinical Cardiac Manifestations - To evaluate patients with diabetes, systemic sclerosis, and other conditions for early cardiac changes.
• Myocardial Ischemia - To assess the impact of ischemia on myocardial function.
• Arterial Hypertension - To evaluate the effects of high blood pressure on the heart muscle.
• Valvular Heart Diseases - To assess the impact of mitral or aortic regurgitation on myocardial function.
• Non-ischemic Cardiomyopathies - To evaluate myocardial mechanics in various forms of cardiomyopathy.
• Acute Heart Failure - To predict outcomes in patients experiencing acute heart failure.

2. Procedure

The myocardial strain imaging procedure involves several key steps to ensure accurate assessment of myocardial mechanics. The following outlines the procedural steps:

• Step 1: Patient Preparation - The patient is positioned appropriately for echocardiography, typically in a left lateral decubitus position, to optimize imaging of the heart. The patient is instructed to hold their breath during the imaging process to minimize motion artifacts.
• Step 2: Image Acquisition - Using a high-resolution ultrasound machine, echocardiographic images are obtained from multiple views, including the apical four-chamber, three-chamber, and two-chamber views, as well as short-axis views at the basal, mid, and apical levels. A minimum of three cardiac cycles is captured for each view to ensure reliable data.
• Step 3: ECG Gating - The ultrasound images are synchronized with the patient's electrocardiogram (ECG) to accurately capture the timing of cardiac cycles, which is crucial for assessing myocardial dynamics during systole and diastole.
• Step 4: Image Analysis - Special software is applied to the acquired images to analyze cardiac motion. This software tracks natural acoustic markers, or speckles, present in the 2D ultrasound images. The tracking occurs frame by frame, allowing for detailed analysis of myocardial motion.
• Step 5: Calculation of Strain Rate - Based on the tracked motion of the speckles, the software calculates the velocity and strain rate of the myocardial tissue, providing quantitative data on myocardial deformation.

3. Post-Procedure

After the myocardial strain imaging procedure, patients may resume normal activities unless otherwise instructed by their healthcare provider. There are typically no specific post-procedure care requirements, as the procedure is non-invasive and does not involve any sedation or invasive techniques. The results of the strain imaging will be analyzed and interpreted by a qualified healthcare professional, who will discuss the findings with the patient and determine any necessary follow-up actions or treatments based on the results. It is essential to document the findings accurately and report code 0399T separately as an adjunct to any primary echocardiography procedure performed during the same session.