Risk Assessment in Patients Unable to Exercise Class I 1. Pharmacological stress with either nuclear MPI or echocardiography is recommended for risk assess- ment in patients with SIHD who are unable to exercise to an adequate workload regardless of interpretability of ECG.7,264 266,287 290 (Level of Evidence: B) Class IIa 1. Pharmacological stress CMR is reasonable for risk assessment in patients with SIHD who are unable to exercise to an adequate workload re- gardless of interpretability of ECG.280 284,291 (Level of Evidence: B) 2. CCTA can be useful as a first-line test for risk assessment in patients with SIHD who are unable to Fihn et al Stable Ischemic Heart Disease: Full Text e383 exercise to an adequate workload regardless of interpretability of ECG.286 (Level of Evidence: C) 3.2.2.3. Risk Assessment Regardless of Patients Ability to Exercise Class I 1. Pharmacological stress with either nuclear MPI or echocardiography is recommended for risk assess- ment in patients with SIHD who have LBBB on ECG, regardless of ability to exercise to an adequate workload.287 290,292 (Level of Evidence: B) 2. Either exercise or pharmacological stress with imag- ing (nuclear MPI, echocardiography, or CMR) is recommended for risk assessment in patients with SIHD who are being considered for revasculariza- tion of known coronary stenosis of unclear physio- logical significance.266,278,293,294 (Level of Evidence: B) Class IIa 1. CCTA can be useful for risk assessment in patients with SIHD who have an indeterminate result from functional testing.286 (Level of Evidence: C) Class IIb 1. CCTA might be considered for risk assessment in patients with SIHD unable to undergo stress imaging or as an alternative to invasive coronary angiogra- phy when functional testing indicates a moderate- to Table 12. 