12
Treatment
6.3. CMR Imaging
COR LOE
Recommendations
1 B-NR
1. For patients suspected of having HCM in whom
echocardiography is inconclusive, CMR imaging is indicated
for diagnostic clarification.
1 B-NR
2. For patients with left ventricular hypertrophy (LVH) in
whom there is a suspicion of alternative diagnoses, including
infiltrative or storage disease as well as athlete's heart, CMR
imaging is useful (Figure 1).
1 B-NR
3. For patients with HCM who are not otherwise identified as
high risk for SCD, or in whom a decision to proceed with
ICD remains uncertain after clinical assessment that includes
personal or family history, echocardiography, and ambulatory
electrocardiographic monitoring, CMR imaging is beneficial
to assess for maximum LV wall thickness, EF, LV apical
aneurysm, and extent of myocardial replacement fibrosis with
late gadolinium enhancement (LGE).
1 B-NR
4. For patients with obstructive HCM in whom the
anatomic mechanism of obstruction is inconclusive on
echocardiography, CMR imaging is indicated to inform the
selection and planning of SRT.
2b C-EO
5. For patients with HCM, repeat contrast-enhanced CMR
imaging on a periodic basis (every 3 to 5 years) for the
purpose of SCD risk stratification may be considered to
evaluate changes in LGE and other morphologic changes,
including EF, development of apical aneurysm, or LV wall
thickness (Figure 1, Table 7).
6.4. Cardiac CT
COR LOE
Recommendation
2b C-LD
1. In adult patients with suspected HCM, cardiac CT may
be considered for diagnosis if the echocardiogram is not
diagnostic and CMR imaging is unavailable.
