Exercise with nuclear MPI or echocardiography is reasonable in patients with known SIHD who have new or worsening symptoms not consistent with UA and who have a) at least moderate physical function- ing and no disabling comorbidity, b) previously required imaging with exercise stress, or c) known multivessel disease or high risk for multivessel dis- ease.1241,1242 (Level of Evidence: B) Class III: No Benefit 1. Pharmacological stress imaging with nuclear MPI, echocardiography, or CMR is not recommended in patients with known SIHD who have new or worsening symptoms not consistent with UA and who are capable of at least moderate physical Fihn et al Stable Ischemic Heart Disease: Full Text e429 functioning or have no disabling comorbidity.333 (Level of Evidence: C) 6.3.1.2. Patients Unable to Exercise Class I 1. Pharmacological stress imaging with nuclear MPI or echocardiography is recommended in patients with known SIHD who have new or worsening symptoms not consistent with UA and who are incapable of at least moderate physical function- ing or have disabling comorbidity.148 150,152 156 (Level of Evidence: B) Class IIa 1. Pharmacological stress imaging with CMR is rea- sonable in patients with known SIHD who have new or worsening symptoms not consistent with UA and who are incapable of at least moderate physical functioning or have disabling comorbidity.280,281,283 (Level of Evidence: B) Class III: No Benefit 1. Standard exercise ECG testing should not be per- formed in patients with known SIHD who have new or worsening symptoms not consistent with UA and who a) are incapable of at least moderate physical functioning or have disabling comorbidity or b) have an uninterpretable ECG. (Level of Evidence: C) 6.3.1.3. Irrespective of Ability to Exercise Class IIb 1. 