Variation in echocardiographic stress and provocation maneuvers for hypertrophic obstructive cardiomyopathy across...

In this nationwide survey, we investigated the use of echocardiographic stress and provocation maneuvers for hypertrophic obstructive cardiomyopathy across Japan. Among 205 echocardiography laboratories, the self-directed Valsalva maneuver was the most commonly used technique. The party balloon inflation maneuver was adopted in a substantial minority of centers as a feasible Valsalva-type provocation maneuver, whereas the goal-directed Valsalva maneuver was rarely used. Maneuver utilization varied by institutional volume. These findings suggest a potential gap between guideline recommendations and real-world practice, underscoring the need for further discussion and harmonization of stress-testing approaches.