• The assessment of myocardial ischaemia remains controversial. Myocardial ischemia may be investigated with functional and/or anatomical imaging tests in patients with chest pain of uncertain aetiology and to assess prognosis.
• For functional imaging of ischaemia, PET or CMR myocardial perfusion imaging, under vasodilators stress, may be used. Alternatively, stress echocardiography CFR assessment of the LAD with concomitant wall motion analysis provides diagnostic and prognostic information and may distinguish between obstructive epicardial CAD and microvascular ischaemia.
• Cardiac CT provides anatomical assessment of the epicardial coronary arteries in HCM (bridging, epicardial CAD and before ASA).
• Nuclear imaging techniques may be useful to study the pathophysiology of ischaemia, metabolism, myocardial receptors and innervation, but their routine clinical use is not recommended.