Are intraventricular gradients a cause of false positive treadmill exercise tests?

Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost.

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Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association

Cardim

Galderisi

Edvardsen

et al. 2015

Eur Heart J Cardiovasc Imaging

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242

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Hypertrophic cardiomyopathy

Cardim¹,

Toste²,

Nijveldt³

2021

The ESC Textbook of Cardiovascular Imaging

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Imaging plays a major role in the evaluation of hypertrophic cardiomyopathy (HCM) patients, offering answers to clinical questions. Imaging techniques provide a broad spectrum of information, including morphological data, functional information, and ischaemia assessment, useful in many clinical settings of HCM. The clinical diagnosis of HCM is based on unexplained left ventricular hypertrophy (LVH) by imaging, though the role of genetic diagnosis has increased. A multimodality imaging (MMI) approach is encouraged in HCM. Each technique must be selected to provide solutions to the specific problems, avoiding duplicated data, and taking into account its technical characteristics, availability, benefits, risks, and costs.

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The role of imaging in the diagnosis and management of hypertrophic cardiomyopathy

Weissler‐Snir

Crean

Rakowski

2015

Expert Review of Cardiovascular Therapy

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Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, affecting approximately 1:500 people. As the yield of genetic testing is only about 35-60%, the diagnosis of HCM is still clinical and based on the demonstration of unexplained and usually asymmetric left ventricular (LV) hypertrophy by imaging modalities. In the past, echocardiography was the sole imaging modality used for the diagnosis and management of HCM. However, in recent years other imaging modalities such as cardiac magnetic resonance have played a major role in the diagnosis, management and risk stratification of HCM, particularly when the location of left ventricular hypertrophy is atypical (apex, lateral wall) and when the echocardiographic imaging is sub-optimal. However, the most unique contribution of cardiac magnetic resonance is the quantification of myocardial fibrosis. Exercise stress echocardiography is the preferred provocative test for the assessment of LV outflow tract obstruction, which is detected only on provocation in one-third of the patients.

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Are intraventricular gradients a cause of false positive treadmill exercise tests?

Cited by 3 publications

References 26 publications

Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association

Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association

Hypertrophic cardiomyopathy

The role of imaging in the diagnosis and management of hypertrophic cardiomyopathy

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