Stress testing in patients with hypertrophic cardiomyopathy

Exercise echocardiography is an important and useful tool for the evaluation of symptoms and monitoring the response to therapy in patients with hypertrophic cardiomyopathy (HCM). A significant number of patients without resting left ventricular outflow tract gradients develop dynamic obstruction with exercise. Detection of an exercise-induced gradient provides a therapeutic target for the relief of symptoms. Abnormal blood pressure response to exercise is an important, although nonspecific, risk factor for cardiovascular death in patients with HCM. Stress testing such as myocardial perfusion imaging lacks specificity in diagnosing coronary artery disease in patients with HCM but has a good negative predictive value. Exercise stress test in controlled environment seems to be safe in properly selected patients with HCM, and benefits of the diagnostic and prognostic information obtained outweigh the small risks.