Monitoring

In general, patients with cardiomyopathy require lifelong follow-up to evaluate changes in symptoms, risk of adverse events, ventricular function, and cardiac rhythm.[1] A shared approach between cardiomyopathy units and general cardiologists is strongly recommended.[1]

All patients should undergo clinical assessment and risk stratification at the time of diagnosis and at 1-2 year intervals, or whenever there is a change in clinical status.[1][2]​​ Such evaluation should include: a detailed family history, with particular emphasis on whether other family members with hypertrophic cardiomyopathy experienced premature death; a detailed history with inquiry into symptoms of chest pain, palpitations, or loss of consciousness; echocardiography; Holter monitoring; ECG; and exercise testing.[2] Cardiac magnetic resonance evaluation should be considered every 2-5 years or more frequently in patients with progressive disease.[1]

Patients with risk factors for sudden death, including nonsustained ventricular tachycardia on sequential Holter monitorings, previous cardiac arrest, extreme hypertrophy, and unexplained syncope, should be closely monitored; implantable cardioverter-defibrillator placement should be considered. See Diagnostic approach for more information on risk stratification.

Frequent follow-up at 6-month intervals is recommended for those with high-risk features for sudden cardiac death (SCD) and focused on mitigation of risk. It is important to note that the European Society of Cardiology risk score was developed from cohort studies of nonathletes and it is difficult to ascertain whether the risk of SCD is further exacerbated by the stressors associated with high-intensity activities.[38] Therefore, further or more frequent screening strategies may be indicated in those participating in high-intensity athletic activities, especially those that are highly dynamic start-stop type exercises. Patients over 65 years of age may have additional prevalent cardiac comorbidities such as hypertension and diabetes that may increase their risk.[112]

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