title: Diagnosis of ischemia in hypertrophic cardiomyopathy: role of computed tomography and nuclear stress testing.
abstract: OBJECTIVE
  Chest pain and myocardial ischemia are common features in patients with hypertrophic cardiomyopathy (HCM). This review addresses diagnostic roles of computed tomography and nuclear stress testing (NST) in patients with HCM.
  
  
  RESULTS
  Current evidence showed the limitation of NST in the diagnosis of epicardial coronary artery stenosis due to the prevalent microvascular dysfunction. In this context, the excellent negative predictive value of coronary computed tomography angiography (CCTA) makes it very attractive to serve as a gatekeeper to invasive angiography in low-risk symptomatic patients, either as the first noninvasive imaging test of choice or after the presence of perfusion defect seen in NST. Furthermore, the identification of coronary atherosclerosis process in the absence of obstructive lesion could have impacts on the management of risk factors for coronary artery disease. We also propose an algorithm for evaluation of ischemia in HCM patients based on the recent evidence.
  
  
  CONCLUSIONS
  In low-intermediate-risk symptomatic patients with HCM, both NST and CCTA are acceptable diagnostic tools for the evaluation of myocardial ischemia. In the presence of nuclear perfusion defect, CCTA can be used to rule out significant epicardial stenosis. Presence of significant major epicardial artery stenosis on CCTA or high-risk patients could be considered for invasive angiography.
authors.affiliation: aHouston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas bDepartment of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA *Dr Kongkiat Chaikriangkrai and Dr Lakshmi Chebrolu contributed equally to the writing of this article.
authors.forename: Kongkiat
authors.initials: K
authors.lastname: Chaikriangkrai
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Chebrolu
authors.forename: Sabha
authors.initials: S
authors.lastname: Bhatti
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000503:physiopathology; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D017023:Coronary Angiography / Q000379:methods; D003937:Diagnosis, Differential; D005080:Exercise Test / Q000379:methods; D006801:Humans; D055806:Microvessels / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods