Echocardiographic Screening Intervals for Hypertrophic Cardiomyopathy

Screening Recommendations

• The American College of Cardiology recommends that transthoracic echocardiography (TTE) studies be performed every 1 to 2 years in symptomatically stable patients with Hypertrophic Cardiomyopathy (HCM) to assess the degree of myocardial hypertrophy, dynamic obstruction, and myocardial function 1, 2, 3
• Repeat TTE is recommended whenever there is a change in clinical status or new cardiovascular event, as suggested by the American College of Cardiology 1, 4
• Annual 12-lead ECGs should accompany echocardiographic monitoring to evaluate for asymptomatic changes in conduction or rhythm, according to the American College of Cardiology and Circulation 5, 6
• 24-hour ambulatory (Holter) electrocardiographic monitoring should be repeated every 1 to 2 years to assess for asymptomatic paroxysmal atrial fibrillation/flutter and to identify patients who may be candidates for ICD therapy, as recommended by the American College of Cardiology and Circulation 1, 5

Screening for Family Members

• For genotype-positive individuals who do not express the HCM phenotype, the American College of Cardiology recommends serial ECG, TTE, and clinical assessment every 12 to 18 months for children and adolescents, and approximately every 5 years for adults 1, 6, 7
• For family members with unknown genetic status, the American College of Cardiology suggests that children under 12 years may not require screening unless there is a malignant family history of premature death, the child is a competitive athlete, symptoms develop, or there is clinical suspicion of early LV hypertrophy 4, 7, 8
• For genotype-negative relatives in families with known definitive mutations, ongoing clinical screening is not indicated, according to the American College of Cardiology and Circulation 1, 5, 9

Special Considerations

• Exercise TTE should be considered in patients with HCM who do not have resting outflow tract obstruction to detect and quantify exercise-induced dynamic LVOT obstruction, as recommended by Circulation 2, 5
• TTE should not be performed more frequently than every 12 months when it is unlikely that any changes have occurred that would impact clinical decision making, according to Circulation 2
• For children of HCM patients, screening should start by age 12 years or earlier if a growth spurt or signs of puberty are evident, especially when there are plans for engaging in intense competitive sports or there is a family history of sudden cardiac death, as suggested by the American College of Cardiology and Circulation 1, 3, 9
• Cardiac MRI should be considered when echocardiography is inconclusive or when additional information about the magnitude and distribution of hypertrophy may impact management decisions, according to Circulation 2