Hypertrophic Cardiomyopathy -Sports-Related Aspects of Diagnosis, Therapy, and Sports Eligibility

Abstract

Hypertrophic cardiomyopathy (HCM) is one of the primary causes of sudden cardiac death in athletes < 35 years of age. The highest risk of sudden cardiac death is associated with syncope, early age, extreme ventricular hypertrophy, ventricular tachycardia, and a family history of sudden death. The relative risk in competitive sports is unknown. Usually, sports eligibility is rejected. However, some athletes with HCM tolerate extreme athletic lifestyles without complications. Sports-related aspects of diagnosis, therapy, and sports eligibility are presented, and discussed. Two case reports are presented: a 20-year-old professional soccer player and a 66-year-old long-distance runner. Athletes with HCM should not participate in most competitive sports with the possible exception of those of low dynamic and low static intensity. Participation in low to moderate athletic activities may be allowed in selected patients without risk factors and > 35 years of age.

Hypertrophic cardiomyopathy - prevention - sports eligibility - sudden cardiac death

References

• 1 Burke A P, Farb A, Virmani R, Goodin J, Smialek J E. Sports related and non-sports related sudden cardiac death in young adults.  Am Heart J. 1991;  121 568 - 575
• 2 Cecchi F, Maron B, Epstein S. Long-term outcome of patients with hypertrophic cardiomyopathy successfully resuscitated after cardiac arrest.  J Am Coll Cardiol. 1989;  13 1283 - 1288
• 3 Corrado D, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes.  N Engl J Med. 1998;  339 364 - 369
• 4 Dickhuth H H, Röcker K, Hipp A, Heitkamp H C, Keul J. Echocardiographic findings in endurance athletes with hypertrophic non-obstructive cardiomyopathy (HNCM) compared to non-athletes with HNCM and to physiological hypertrophy (athlete's heart).  Int J Sports Med. 1994;  15 273 - 277
• 5 Elliott P M, Poloniecki J, Dickie S, Sharma S, Monserrat L, Varnava A, Mahon N G, McKenna W J. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients.  J Am Coll Cardiol. 2000;  36 2212 - 2218
• 6 Faber L, Meissner A, Ziemssen P, Seggewiss H. Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long-term follow up of the first series of 25 patients.  Heart. 2000;  83 326 - 331
• 7 Geisterfer-Lowrance A A, Christe M, Conner D A, Ingwall J S, Schoen F J, Seidman C E, Seidman J G. A mouse model of familial hypertrophic cardiomyopathy.  Science. 1996;  272 731 - 734
• 8 Hagège A A, Dubourg O, Desnos M, Mirochnik R, Isnard G, Bonne G, Carrier L, Guicheney P, Bouhour J B, Schwartz K, Komajda M. Familial hypertrophic cardiomyopathy - cardiac ultrasonic abnormalities in genetically affected subjects without echocardiographic evidence of left ventricular hypertrophy.  Eur Heart J. 1998;  19 490 - 499
• 9 International Federation of Sports Medicine (FIMS) .Scientific Committee Recommendations for medical evaluation and sports participation in athletes with a family history of sudden cardiac death. In: International Sports Medicine Directory. Human Kinetics 2001: 247-248
• 10 Lim D S, Lutucuta S, Bachireddy P, Youker K, Evans A, Entman M, Roberts R, Marian A J. Angiotensin II blockade reverses myocardial fibrosis in a transgenic mouse model of human hypertrophic cardiomyopathy.  Circulation . 2001;  103 789 - 791
• 11 Malik M. Heart rate variability. Standards of measurement, physiological interpretation and clinical use.  Circulation. 1996;  93 1043 - 1065
• 12 Marian A, Roberts R. The molecular genetic basis for hypertrophic cardiomyopathy.  J Mol Cell Cardiol. 2001;  33 655 - 670
• 13 Maron B J. Hypertrophic cardiomyopathy - a systematic review.  J Am Med Ass. 2002;  287 1308 - 1320
• 14 Maron B J, Bonow R O, Cannon R O, Leon M B, Epstein S E. Hypertrophic cardiomyopathy: interrelation of clinical manifestations, pathophysiology, and therapy.  N Engl J Med. 1987;  316 844 - 852
• 15 Maron B J, Casey S A, Poliac L C, Gohman T E, Almquist A K, Aeppli D M. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort.  J Am Med Ass. 1999;  281 650 - 655
• 16 Maron B J, Cecchi F, McKenna W J. Risk factors and current status of risk stratification profiles for sudden cardiac death in patients with hypertrophic cardiomyopathy.  Br Heart J. 1994;  72 (suppl) 14 - 18
• 17 Maron B J, Epstein S E, Roberts W C. Hypertrophic cardiomyopathy and transmural myocardial infarction without significant atherosclerosis of the extramural coronary arteries.  Am J Cardiol. 1979;  43 1086 - 1102
• 18 Maron B J, Fananapazir L. Sudden cardiac death in hypertrophic cardiomyopathy.  Circulation. 1992;  85 (suppl 1) 57 - 63
• 19 Maron B J, Isner J M, McKenna W J. Task Force 3: Hypertrophic cardiomyopathy, myocarditis and other myocardial diseases and mitral valve prolapse.  J Am Coll Cardiol. 1994;  24 880 - 882
• 20 Maron B J, Klues H G. Surviving competitive athletics with hypertrophic cardiomyopathy.  Am J Cardiol. 1994;  73 1098 - 1104
• 21 Maron B J, Moller J H, Seidman C E, Vincent G M, Dietz H C, Moss A J, Towbin J A, Sondheimer H M, Pyeritz R E, McGee G, Epstein A E. Impact of laboratory molecular diagnosis on contemporary diagnostic criteria for genetically transmitted cardiovascular diseases: hypertrophic cardiomyopathy, long QT-syndrome, and Marfan syndrome: a statement for healthcare professionals from the councils on clinical cardiology, cardiovascular disease in the young, and basic science, American Heart Association.  Circulation. 1998;  98 1460 - 1471
• 22 Maron B J, Nishimura R A, McKenna W J, Rakowski H, Josephson M E, Kieval R S. Assessment of permanent dual chamber pacing as a treatment for drug refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-Pathy).  Circulation. 1999;  99 2927 - 2933
• 23 Maron B J, Roberts W C, Epstein S E. Sudden death in hypertrophic cardiomyopathy: a profile of 78 patients.  Circulation. 1982;  67 1388 - 1394
• 24 Maron B J, Shen W K, Link M S, Epstein A E, Almquist A K, Daubert J P, Bardy G H, Favale S, Rea R F, Boriani G, Ill M E, Spirito P. Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy.  N Engl J Med. 2000;  342 365 - 373
• 25 Maron MS, Olivotto I, Betocchi S, Casey S A, Lesser J R, Losi M A, Cecchi F, Maron B J. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy.  N Engl J Med. 2003;  348 295 - 303
• 26 McKenna W J, Camm A J. Sudden death in hypertrophic cardiomyopathy. Assessment of patients at high risk.  Circulation. 1989;  80 1489 - 1492
• 27 McKenna W J, Coccolo F, Elliott P M. Genes and disease expression in hypertrophic cardiomyopathy.  Lancet. 1998;  352 1162 - 1163
• 28 McKenna W J, Oakley C M, Krikler D M, Goodwin J F. Improved survival with amiodarone in patients with hypertrophic cardiomyopathy and ventricular tachycardia.  Br Heart J. 1985;  53 412 - 416
• 29 Mitchell J H, Haskel W L, Raven P B. Classification of sports.  J Am Coll Cardiol. 1994;  24 864 - 866
• 30 Mohiddin S A, Begley D, Shih J, Fananapazir L. Myocardial bridging does not predict sudden death in children with hypertrophic cardiomyopathy but is associated with more severe cardiac disease.  J Am Coll Cardiol. 2000;  36 2270 - 2278
• 31 Momiyama Y, Hartikainen J, Nagayoshi H, Albrecht P, Kautzner J, Saumarez R C, McKenna W J, Camm A J. Exercise-induced T-wave alternans as a marker of high risk in patients with hypertrophic cardiomyopathy.  Japn Circ J. 1997;  61 650 - 656
• 32 Murda’h M, McKenna W J, Camm A J. Repolarization alternans: Techniques, mechanisms, and cardiac vulnerability.  Pace. 1997;  20 2641 - 2657
• 33 Nagueh S, Bachinski L, Meyer D, Hill R, Zoghbi W A, Tam J W, Quinones M A, Roberts R, Marian A J. Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy.  Circulation. 2001;  104 128 - 130
• 34 Olivotto I, Montereggi A, Mazzuoli F, Cecchi F. Clinical utility and safety of exercise testing in patients with hypertrophic cardiomyopathy.  G Ital Cardiol. 1999;  29 11 - 19
• 35 Ostman-Smith I, Wettrell G, Riesenfeld T. A cohort study of childhood hypertrophic cardiomyopathy: improved survival following high-dose β-adrenoceptor antagonist treatment.  J Am Coll Cardiol. 1999;  34 1813 - 1822
• 36 Pinsky D J, Sciacca R R, Steinberg J S. QT-Dispersion as a marker of risk in patients awaiting heart transplantation.  J Am Coll Cardiol. 1997;  29 1576 - 1584
• 37 Raschka C, Parzeller M, Kind M, Banzer W. Organpathologische Ursachen des akuten Sporttodes in Deutschland, Österreich und der deutschsprachigen Schweiz.  Deutsch Z Sportmed. 1998;  49 157 - 160
• 38 Roberts R, Sigwart U. New concepts in hypertrophic cardiomyopathies, part I.  Circulation. 2001;  104 2113 - 2116
• 39 Roberts R, Sigwart U. New concepts in hypertrophic cardiomyopathies, part II.  Circulation. 2001;  104 2249 - 2252
• 40 Spirito P, Maron B J. Perspectives on the role of new treatment strategies in hypertrophic obstructive cardiomyopathy.  J Am Coll Cardiol. 1999;  33 1071 - 1075
• 41 Spirito P, Seidman C E, McKenna W J, Maron B J. The management of hypertrophic cardiomyopathy.  N Engl J Med. 1997;  336 775 - 785
• 42 Tabib A, Miras A, Taniere P, Loire R. Undetected cardiac lesions cause unexpected sudden cardiac death during occasional sport activity - a report on 80 cases.  Eur Heart J. 1999;  20 900 - 903
• 43 Varnava A, Baboonian C, Davison F, de Cruz L, Elliott P M, Davies M J, McKenna W J. A new mutation of the cardiac troponin T gene causing familial hypertrophic cardiomyopathy without left ventricular hypertrophy.  Heart. 1999;  82 621 - 624
• 44 Watkins H. Sudden death in hypertrophic cardiomyopathy.  N Engl J Med. 2000;  342 422 - 423
• 45 Yetman A T, McCrindle B W, MacDonald C, Freedom R M, Gow R. Myocardial bridging in children with hypertrophic cardiomyopathy - a risk factor for sudden death.  N Engl J Med. 1998;  339 1201 - 1209