Table 1 Proposal of Echo-Doppler exercise echocardiography

1. Period of 12-h fasting before exercise

[7]

2. Physiological exercise test for LVOTG provocation

A/ Pre-exercise stage – echocardiography first in supine position and then in upright position

In some patients rapid emergence or increase in LVOTG has been reported after mere standing prior to orthostatic stress testing; under such circumstances, exercise provocation is not only unnecessary but even contraindicated, because of the risk of syncope.

B/ Position during exercise – upright

C/ Exercise gradient monitoring – continuous

D/ Moment of gradient measurement by Doppler echocardiography – peak exercise

E/ Mode of exercise – treadmill

bicycle can be confidently used to acquire peak images, but peak O₂ consumption is lower than that achieved by treadmill, which might lead to lower sensitivity. In addition, in contrast to treadmill, leg discomfort or lack of leg strength is a common reason for terminating prematurely the bicycling test.

F/ Termination of test – symptom-limited;

alternatively, pre-specified heart rate/workload (or combination).

G/ Post-exercise recovery – continuous monitoring of LVOTG in upright position

Full protocol in treadmill 2A-G [8–13]