Guideline+for+the++Diagnosis+and+Treatment+of+Hype

ACCF/AHAPocketGuidelineAdaptedfromthe2011ACCF/AHAGuidelinefortheDiagnosisandTreatmentofHypertrophicCardiomyopathyNovember2011DevelopedinCollaborationWiththeAmericanAssociationforThoracicSurgery,AmericanSocietyofEchocardiography,AmericanSocietyofNuclearCardiology,HeartFailureSocietyofAmerica,HeartRhythmSociety,SocietyforCardiovascularAngiographyandInterventions,andSocietyofThoracicSurgeons©2011bytheAmericanCollegeofCardiologyFoundationandtheAmericanHeartAssociation,Inc.Thefollowingmaterialwasadaptedfromthe2011ACCF/AHAGuidelinesfortheDiagnosisandTreatmentofHypertrophicCardiomyopathy(JAmCollCardiol2011;XX:XX–XX).ThispocketguidelineisavailableontheWorldWideWebsitesoftheAmericanCollegeofCardiology()andtheAmericanHeartAssociation(my.americanheart.org).Forcopiesofthisdocument,pleasecontactElsevierInc.ReprintDepartment,e-mail:[e-mail];phone:[phone];fax:[phone].Permissions:Multiplecopies,modification,alteration,enhancement,and/ordistributionofthisdocumentarenotpermittedwithouttheexpresspermissionoftheAmericanCollegeofCardiologyFoundation.PleasecontactElsevier’[e-mail].........................................................................................32.ClinicalDefinition................................................................................63.GeneticTestingStrategies/FamilyScreening.....................................74.Genotype-Positive/Phenotype-NegativePatients.............................95.Echocardiography..............................................................................106.StressTesting.....................................................................................147.CardiacMagneticResonance............................................................158.DetectionofConcomitantCoronaryDisease...................................179.AsymptomaticPatients.....................................................................1910.PharmacologicManagement...........................................................2111.InvasiveTherapies...........................................................................26212.Pacing..............................................................................................2913.SuddenCardiacDeathRiskStratification.....................................3014.SelectionofPatientsforImplantableCardioverter-Defibrillators...3215.ParticipationinCompetitiveorRecreationalSportsandPhysicalActivity......................................................................3616.ManagementofAtrialFibrillation.................................................3817.Pregnancy/Delivery........................................................................4131.IntroductionTheimpetusfortheguidelinesisbasedonanappreciationofthefrequencyofthisclinicalentityandarealizationthatmanyaspectsofclinicalmanagement,includingtheuseofdiagnosticmodalities,genetictesting,utilizationofimplantablecardioverter-defibrillators(ICDs),andtherapiesforrefractorysymptomslackconsensus.ThediscussionandrecommendationsaboutthevariousdiagnosticmodalitiesapplytopatientswithestablishedHCMandtoavariableextenttopatientswithahighindexofsuspicionofthedisease.ClassificationofRecommendationsTheACCF/AHAclassificationsofrecommendationsandlevelsofevidenceareutilized,anddescribedinmoredetailinTable1.4ClassIIbBenefitRiskAdditionalstudieswithbroadobjectivesneeded;additionalregistrydatawouldbehelpfulProcedure/TreatmentmaybeConsIderednRecommendation’susefulness/efficacylesswellestablishednGreaterconflictingevidencefrommultiplerandomizedtrialsormeta-analysesnRecommendation’susefulness/efficacylesswellestablishednGreaterconflictingevidencefromsinglerandomizedtrialornonrandomizedstudiesnRecommendation’susefulness/efficacylesswellestablishednOnlydivergingexpertopinion,casestudies,orstandardofcareClassIIaBenefitRiskAdditionalstudieswithfocusedobjectivesneededItIsreasonabletoper-formprocedure/administertreatmentnRecommendationinfavoroftreatmentorprocedurebeinguseful/effectivenSomeconflictingevidencefrommultiplerandomizedtrialsormeta-analysesnRecommendationinfavoroftreatmentorprocedurebeinguseful/effectivenSomeconflictingevidencefromsinglerandomizedtrialornonrandomizedstudiesnRecommendationinfavoroftreatmentorprocedurebeinguseful/effectivenOnlydivergingexpertopinion,casestudies,orstandardofcareClassIBenefitRiskProcedure/Treatmentshouldbeperformed/administerednRecommendationthatprocedureortreatmentisuseful/effectivenSufficientevidencefrommultiplerandomizedtrialsormeta-analysesnRecommendationthatprocedureortreatmentisuseful/effectivenEvidencefromsinglerandomizedtrialornonrandomizedstudiesnRecommendationthatprocedureortreatmentisuseful/effectivenOnlyexpertopinion,casestudies,orstandardofcarelevelaMultiplepopulationsevaluated*Dataderivedfrommultiplerandomizedclinicaltrialsormeta-analyseslevelbLimitedpopulationsevaluated*DataderivedfromasinglerandomizedtrialornonrandomizedstudieslevelCVerylimitedpopulationsevaluated*Only