Patients should be able to achieve 85% of age-predicted maximum heart rate. CCTA indicates cardiac computed tomography angiography; CMR, cardiac magnetic resonance imaging; COR, class of recommendation; ECG, electrocardiogram; Echo, echocardiography; LBBB, left bundle-branch block; LOE, level of evidence; MPI, myocardial perfusion imaging; and N/A, not available. Exercise Echo or pharmacological stress with MPI or Echo 1. Exercise echo or pharmacological stress with either nuclear MPI or echocardiography is recommended for risk assessment in patients with SIHD who have LBBB on ECG, regardless of ability to exercise to an (Level of Evidence: B) high-risk result and knowledge of angiographic cor- onary anatomy is unknown. (Level of Evidence: C) Class III: No Benefit 1. A request to perform either a) more than 1 stress imaging study or b) a stress imaging study and a CCTA at the same time is not recommended for risk assessment in patients with SIHD. (Level of Evidence: C) See Online Data Supplement 2 for additional data on risk assessment. 3.2.2.4. Exercise ECG To assess the risk of cardiovascular events in patients who are able to exercise to an adequate workload and have an interpretable resting ECG, exercise is the preferred stressor because it provides an objective assessment of functional capacity and correlative information with activities of daily living. 