14
Treatment
6.7. Exercise Stress Testing
COR LOE
Recommendations
1 B-NR
1. For symptomatic patients with HCM who do not have
resting or provocable outflow tract peak gradient ≥50 mm
Hg on TTE, exercise TTE is recommended for the detection
and quantification of dynamic LVOTO.
1 B-NR
2. In patients with nonobstructive HCM and advanced HF
(NYHA functional class III to class IV), cardiopulmonary
exercise stress testing should be performed to quantify the
degree of functional limitation and aid in selection of patients
for heart transplantation or mechanical circulatory support.
1 B-NR
3. In pediatric patients with HCM, regardless of symptom
status, exercise stress testing is recommended to determine
functional capacity and to provide prognostic information.
2a B-NR
4. In adult patients with HCM, exercise stress testing is
reasonable to determine functional capacity and to provide
prognostic information as part of initial evaluation.
2a C-LD
5. For asymptomatic patients with HCM who do not have a
resting or provocable outflow tract peak gradient ≥50 mm
Hg on standard TTE, exercise TTE is reasonable for the
detection and quantification of dynamic LVOTO.
2b C-LD
6. In patients with obstructive HCM and ambiguous functional
capacity, exercise stress testing may be reasonable to guide
therapy (Figure 1).
2b C-EO
7. In patients with HCM for whom it is unclear if their
functional capacity has declined, exercise stress testing may be
considered every 2 to 3 years (Figure 1).
6.8. Genetics and Family Screening
COR LOE
Recommendations
1 B-NR
1. In patients with HCM, evaluation of familial inheritance,
including a 3-generation family history, is recommended as
part of the initial assessment.
1 B-NR
2. In patients with HCM, genetic testing is beneficial to elucidate
the genetic basis to facilitate the identification of family
members at risk for developing HCM (cascade testing ).
1 B-NR
3. In patients with an atypical clinical presentation of HCM
or when another genetic condition is suspected to be the
cause, a workup including genetic testing for HCM and other
genetic causes of unexplained cardiac hypertrophy ("HCM
phenocopies") is recommended.
