View source for Cardiomyopathy 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy

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{{Cardiomyopathy}}
{{CMG}}; {{AE}} {{EdzelCo}}

==2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy <ref name="pmid33215938">{{cite journal| author=Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P | display-authors=etal| title=2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2020 | volume= 142 | issue= 25 | pages= e533-e557 | pmid=33215938 | doi=10.1161/CIR.0000000000000938 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33215938  }} </ref> ==




====<u> Recommendation for Shared Decision-Making </u>====

{|class="wikitable" style="width:80%"
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|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| bgcolor="LightGray"|1. For [[patients]] with [[HCM]] or at risk for [[HCM]], shared decision-making is recommended in developing a plan of [[care]] (including but not limited to decisions regarding [[genetic]] evaluation, activity, [[lifestyle]], and [[therapy]] choices) that includes a full disclosure of the risks, benefits, and anticipated outcomes of all options, as well the opportunity for the [[patient]] to express their goals and concerns. 
|bgcolor= "Turquoise"; style="text-align:center;|B-NR
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====<u> Recommendation for Multidisciplinary HCM Centers </u>====

{|class="wikitable" style="width:80%"
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|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| bgcolor="LightGray"|1. In [[patients]] with [[HCM]] in whom [[septal reduction therapy]] ([[SRT]]) is indicated, the procedure should be performed at experienced centers (comprehensive or primary HCM centers) with demonstrated excellence in [[clinical]] outcomes for these procedures. 
|bgcolor= "PaleTurquoise"; style="text-align:center;|C-LD
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|colspan="1" style="text-align:center; background:Gold"| [[ESC #Classification of Recommendations|Class IIa]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
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| bgcolor="LightGray"|2. In [[patients]] with [[HCM]], consultation with or referral to a comprehensive or primary HCM center is reasonable to aid in complex [[disease]]-related management decisions.
|bgcolor= "PaleTurquoise"; style="text-align:center;|C-LD
|}

====<u> Recommendation for Diagnosis, Initial Evaluation, and Follow-up </u>====

{|class="wikitable" style="width:80%"
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|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
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| bgcolor="LightGray"|1. In [[patients]] with suspected [[HCM]], comprehensive [[physical examination]] and complete [[medical]] and 3-[[generation]] [[family history]] is recommended as part of the initial [[diagnostic]] assessment. 
|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|}

====<u> Recommendation for Echocardiography </u>====

{|class="wikitable" style="width:80%"
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|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
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| bgcolor="LightGray"|1. In [[patients]] with suspected [[HCM]], a [[trans-thoracic echocardiogram]] ([[TTE]]) is recommended in the initial evaluations. 
|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |2. In [[patients]] with [[HCM]] with no change in [[clinical status]] or events, repeat [[TTE]] is recommended every 1 to 2 years to assess the degree of [[myocardial]] [[hypertrophy]], dynamic [[left ventricular outflow tract obstruction]] ([[LVOTO]]), [[mitral regurgitation]], and [[myocardial function]].
|-
|bgcolor= "Turquoise"; style="text-align:center;|B-NR children
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |2. In [[patients]] with [[HCM]] with no change in [[clinical status]] or events, repeat [[TTE]] is recommended every 1 to 2 years to assess the degree of [[myocardial]] [[hypertrophy]], dynamic [[left ventricular outflow tract obstruction]] ([[LVOTO]]), [[mitral regurgitation]], and [[myocardial function]].
|-
|bgcolor= "PaleTurquoise"; style="text-align:center;|C-LD adult
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
|rowspan="2" bgcolor="LightGray" |3. For [[patients]] with [[HCM]] who experience a change in [[clinical status]] or a new [[clinical event]], repeat [[TTE]] is recommended.
|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
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| rowspan="2" bgcolor="LightGray" |4. For [[[patients]] with [[HCM]] and resting [[left ventricular outflow tract]] gradient <50 mm Hg, a [[TTE]] with provocative maneuvers is recommended.
|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |6. For [[symptomatic]] [[patients]] with [[HCM]] who do not have a resting or provocable outflow tract gradient ≥50 mm Hg on [[TTE]], exercise [[TTE]] is recommended for the detection and quantification of dynamic [[LVOTO]].
|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |7. For [[patients]] with [[HCM]] undergoing [[surgical]] [[septal myectomy]], [[intraoperative]] [[transesophageal echocardiogram]] ([[TEE]]) is recommended to assess [[mitral valve anatomy]] and [[function]] and adequacy of [[septal myectomy]].
|-|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |8. For [[patients]] with [[HCM]] undergoing [[alcohol septal ablation]], [[TTE]] or [[intraoperative]] [[TEE]] with [[intracoronary]] [[ultrasound]]-enhancing [[contrast]] injection of the candidate’s [[septal perforator]](s) is recommended.
|-|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |9. [[Screening]]: In first-degree relatives of [[patients]] with [[HCM]], a [[TTE]] is recommended as part of initial [[family screening]] and periodic  [[follow-up]].
|-|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|-
|colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |10. Screening: In individuals who are [[genotype]]-positive or [[phenotype]]-negative, serial [[echocardiography]] is recommended at periodic intervals depending on age (1 to 2 years in [[children]] and [[adolescents]], 3 to 5 years in adults) and change in [[clinical status]].
|-|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|-
|colspan="1" style="text-align:center; background:Gold"| [[ESC #Classification of Recommendations|Class IIa]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |11. For [[patients]] with [[HCM]], [[TEE]] can be useful if [[TTE]] is inconclusive in [[clinical]] decision-making regarding [[medical]] [[therapy]], and in situations such as planning for [[myectomy]], exclusion of [[subaortic]] membrane or [[mitral regurgitation]] secondary to structural abnormalities of the [[mitral valve apparatus]], or in the assessment of the feasibility of [[alcohol septal ablation]].
|-
|bgcolor= "PaleTurquoise"; style="text-align:center;|C-LD
|-
|colspan="1" style="text-align:center; background:Gold"| [[ESC #Classification of Recommendations|Class IIa]]
|colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
|-
| rowspan="2" bgcolor="LightGray" |12. For [[patients]] with [[HCM]] in whom the [[diagnoses]] of [[apical HCM]], [[apical aneurysm]], or atypical patterns of [[hypertrophy]] is inconclusive on [[TTE]], the use of an [[intravenous]] [[ultrasound]]-enhancing agent is reasonable particularly if other imaging modalities such as [[cardiovascular magnetic resonance]] ([[CMR]) are not readily available or contraindicated.
|-
|bgcolor= "Turquoise"; style="text-align:center;|B-NR
|}

==References==