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Table 12 Recommendations for CMR in HCM

From: Representation of cardiovascular magnetic resonance in the AHA / ACC guidelines

  Classa Levelb Page
CMR for the diagnosis of HCM    
 CMR imaging is indicated in patients with suspected HCM when echocardiography is inconclusive for diagnosis. I B 14
 CMR imaging is indicated in patients with known HCM when additional information that may have an impact on management or decision making regarding invasive management, such as magnitude and distribution of hypertrophy or anatomy of the mitral valve apparatus or papillary muscles, is not adequately defined with echocardiography. I B 14
 CMR imaging is reasonable in patients with HCM to define apical hypertrophy and/or aneurysm if echocardiography is inconclusive. IIa B 14
 CMR imaging may be considered in patients with LV hypertrophy and the suspicion of alternative diagnoses to HCM, including cardiac amyloidosis, Fabry disease, and genetic phenocopies such as LAMP2 cardiomyopathy. IIb C 14
CMR for risk stratification in HCM
 In selected patients with known HCM, when SCD risk stratification is inconclusive after documentation of the conventional risk factors, CMR imaging with assessment of late gadolinium enhancement (LGE) may be considered in resolving clinical decision making. IIb C 14
 The usefulness of the following potential SCD risk modifiers is unclear but might be considered in selected patients with HCM for whom risk remains borderline after documentation of conventional risk factors: CMR imaging with LGE. IIb C 27
  1. aClass of recommendation
  2. bLevel of evidence