A Comprehensive Review of Stress Testing in Hypertrophic Cardiomyopathy: Assessment of Functional Capacity, Identification of Prognostic Indicators, and Detection of Coronary Artery Disease.

Hypertrophic cardiomyopathy is a heterogeneous condition that may present with functional limitation due to dyspnea on exertion, angina, or symptoms of heart failure. Although angina is a common symptom, it is thought to be multifactorial, including abnormal microvasculature and epicardial coronary artery disease. The role of stress testing in the detection of coronary artery disease and its limitations are discussed in this review. Stress testing yields additional information beyond the detection of ischemia, which is prognostic independent of the presence of coronary artery disease and can be beneficial in defining the presence of provocable left ventricular outflow tract obstruction, symptoms, response of heart rate and blood pressure to exercise, and functional capacity. Additional noninvasive imaging techniques, including speckle-tracking echocardiography and coronary flow velocity reserve, positron emission tomographic myocardial blood flow, delayed enhancement on cardiac magnetic resonance imaging, and computed tomographic angiography, are also discussed.