Exercise Echocardiography in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a relatively frequent genetic disease that affects 1/500 human beings. Main problems with this disease are the development of symptoms in 10-20% of affected individuals, and the increased risk of sudden cardiac death (SCD) in a subset of patients with the disease. It is important to clarify the cause of symptoms and to assess the risk of sudden death in HCM because we do have therapies to relief these problems. Main causes of symptoms in HCM are related to either LV outflow tract or mid ventricular obstruction, LV diastolic dysfunction, and myocardial ischemia. Drug refractory heart failure symptoms due to LV obstruction may be successfully treated by septal myotomymyectomy. Alcohol septal ablation or dual-chamber pacemaker are reserved as alternatives to surgery. Indeed, exercise may have a role in discerning the role of LV obstruction as a cause of symptoms in these patients. A comprehensive exercise echocardiography approach can discover a truly symptomatic status in minimally symptomatic or asymptomatic patients, as well as measure LV obstruction, mitral regurgitation (MR) and global and regional wall motion response to exercise (Figures 1 and 2). Recent guidelines recognize exercise echocardiography as a safe and important adjunct in the management of HCM [1].