We recommend that noninvasive imaging for patients with HF be considered to determine the presence or absence of coronary artery disease (CAD).
(Strong Recommendation, Moderate-Quality Evidence)

Values and preferences: This recommendation places value on identification of CAD, which might identify the cause of HF, have prognostic implications, and require treatments aimed toward secondary vascular prevention.

We recommend that coronary angiography be:

1. Performed in patients with HF with ischemic symptoms and who are likely to be good candidates for revascularization (Strong Recommendation, Moderate-Quality Evidence).
2. Considered in patients with systolic HF, LVEF < 35%, at risk of CAD, irrespective of angina, who might be good candidates for revascularization (Strong Recommendation, Low-Quality Evidence).
3. Considered in patients with systolic HF and in whom noninvasive coronary perfusion testing yields features consistent with high risk (Strong Recommendation, Moderate-Quality Evidence).

Values and preferences: These recommendations place value on the need for coronary angiography to identify CAD amenable to revascularization. Available evidence suggests that coronary revascularization might provide quality of life and prognostic benefits to patients with HF and noninvasive imaging delineating high risk. In particular, patients with systolic HF because of ischemic heart disease might derive clinical benefit from coronary revascularization even in the absence of angina or reversible ischemia.