Abstract
Hypertrophic cardiomyopathy (HCM) is a genetically determined, primary myocardial disease associated with an increased risk for sudden cardiac death during physical exertion. In the United States, HCM is the most frequent cause of exertion-related sudden cardiac death (SCD). Current recommendations provided by the 26th Bethesda Conference entitled Recommendations for Determining Eligibility for Competition in Athletes with Cardiovascular Abnormalities restrict participation for patients with HCM to sports requiring low levels of dynamic and isometric exertion. Such recommendations are prudent given the association of the disease with disastrous cardiovascular consequences. Nevertheless, because the prognosis of HCM and its risk of sudden death is typified by great variability among patients, these recommendations may be overly restrictive for many patients with this disease, and it is possible that a subset of low-risk patients can be identified who may continue to engage in more vigorous exercise activities. This article presents our current understanding and approach to evaluating and advising athletes with HCM.
Similar content being viewed by others
References and Recommended Reading
Van CampSP, Bloor CM, Mueller FO, et al.: Nontraumatic sports deaths in high school and college athletes. Med Sci Sports Exerc 1995, 27:641–647.
Cantwell JD: Preparticipation physical evaluation: getting to the heart of the matter. Med Sci Sports Exerc 1998, 30:S341-S344.
Maron BJ, Thompson PD, Puffer JC, et al.: Cardiovascular preparticipation screening of competitive athletes: a statement for health professionals from the sudden death committee (clinical cardiology) and congenital cardiac defects committee (cardiovascular disease in the young). AHA. Circulation 1996, 94:850–856.
Maron BJ, Mitchell JH: 26th Bethesda Conference: revised recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. J Am Coll Cardiol 1994, 24:845–899.
Maron BJ, Pelliccia A, Spirito P: Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete’s heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 1995, 91:1596–1601. Distinguishing between hypertrophic cardiomyopathy and the physiologic changes that occur with exercise training can be difficult, because exercise training may result in mild (and rarely) moderate degrees of left ventricular hypertrophy. This article highlights the subtle but important differences between the two conditions.
Marian AJ: sudden cardiac death in patients with hypertrophic cardiomyopathy: from bench to bedside with an emphasis on genetic markers. Clin Cardiol 1995, 18:189–198. An important review of some of the genetic mutations associated with high risk of sudden death.
Basso C, Corrado D, Thiene G: cardiovascular causes of sudden death in young individuals including athletes. Cardiol Rev 1999, 7:127–135.
Maron BJ, Gardin JM, Flack JM, et al.: Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the cardia study. Coronary artery development in (young) adults. Circulation 1995, 92:785–789.
Spirito P, Seidman CE, McKenna WJ, Maron BJ: The management of hypertrophic cardiomyopathy. N Engl J Med 1997, 336:775–785. A comprehensive report on the contemporary treatment of the condition including pharmacologic and nonpharmacologic therapies. The article provides an outline on how and for whom to select each of the available therapeutic options.
Corrado D, Basso C, Schiavon M, Thiene G: screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998, 339:364–369.
Hauser RG: Genetic markers of ventricular hypertrophy. Am J Cardiol 1997, 79:12–15.
Maron BJ, Mathenge R, Casey SA, et al.: Clinical profile of hypertrophic cardiomyopathy identified de novo in rural communities. J Am Coll Cardiol 1999, 33:1590–1595.
Takagi E, Yamakado T, Nakano T: Prognosis of completely asymptomatic adult patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1999, 33:206–211.
Ommen SR, Tajik AJ: Hypertrophic cardiomyopathy: from bedside to bench … and now back again? Circulation 2001, 104:126–127. This editorial highlights some of the pitfalls of screening asymptomatic relatives of cases of hypertrophic cardiomyopathy.
Ho CY, Lever HM, DeSanctis R, et al.: Homozygous mutation in cardiac troponin T. Implications for hypertrophic cardiomyopathy. Circulation 2000, 102:1950–1955.
Moolman JC, Corfield VA, Posen B, et al.: Sudden death due to troponin T mutations. J Am Coll Cardiol 1997, 29:549–555.
Varnava AM, Elliott PM, Mahon N, et al.: Relation between myocyte disarray and outcome in hypertrophic cardiomyopathy. Am J Cardiol 2001, 88:275–279.
Kato M, Takazawa K, Kimura A, et al.: Altered actin binding with myosin mutation in hypertrophic cardiomyopathy and sudden death. Lancet 1995, 345:1247.
Nagueh SF, Bachinski LL, Meyer D, et al.: 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.
Marian AJ, Yu Q, Workman R, et al.: Angiotensin-converting enzyme polymorphism in hypertrophic cardiomyopathy and sudden cardiac death. Lancet 1993, 342:1085–1086.
Louie EK, Edwards III LC:.Hypertrophic cardiomyopathy. Prog Cardiovasc Dis 1994, 36:275–308.
Maron BJ: Hypertrophic cardiomyopathy. Lancet 1997, 350:127–133. A comprehensive review of our current understanding of the pathophysiology and natural history of this condition.
Drezner JA: sudden cardiac death in young athletes. Causes, athlete’s heart, and screening guidelines. Postgrad Med 2000, 108:37–50.
DeRose JJ, Banas JS, Winters SL: current perspectives on sudden cardiac death in hypertrophic cardiomyopathy. Prog Cardiovasc Dis 1994, 6:475–484.
Grace AA, Brady PA, Shapiro LM: Risk management in hypertrophic cardiomyopathy. Lancet 2001, 357:407–408.
Maron BJ: Triggeres for sudden cardiac death in the athlete. Cardiol Clin 1996, 14:195–210.
Maron BJ, Olivotto I, Spirito P, et al.: Epidemiology of hypertrophic cardiomyopathy-related death revisited in a large non-referral based patient population. Circulation 2000, 102:858–864.
Fananapazir L, McAreavey ?: Hypertrophic cardiomyopathy: evaluation and treatment of patients at high risk for sudden death. PACE 1997, 20:478–501.
Elliott PM, Poloniecki J, Dickie S, et al.: Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 2000, 36:2212–2218. This registry study confirms the prognostic value of the major risk factors for sudden death in patients with HCM, and also identifies the relative importance of each of these clinical variables.
Maron BJ: hypertrophic cardiomyopathy and sudden death: new perspectives on risk stratification and prevention with the implantable cardioverter-defibrillator. Eur Heart J 2000, 21:1979–1983. This report highlights important new data of the efficacy of the implantable defibrillator in the primary and secondary prevention of sudden death in HCM. The data also corroborate the high risk for sudden death associated with certain clinical variables, and the utility of risk stratification based on these variables.
Sadoul N, Prasad K, Elliot PM, et al.: Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy. Circulation 1997, 96:2987–2991. An abnormal blood pressure response to exercise has been associated with HCM for a number of years. This is the first study to prospectively identify the poor prognosis associated with an abnormal blood pressure response to exercise.
Elliott PM, Gimenco Blanes JR, Mahon NG, et al.: Relation between severity of left ventricular hypertrophy and prognosis in patients with hypertrophic cardiomyopathy. Lancet 2001, 357:420–424. The study confirms the prognostic significance of severe degrees of LV hypertrophy and risk for sudden death.
Olivotto I, Maron BJ, Montereggi A, et al.: Prognostic value of systemic blood pressure response during exercise in a community based population with hypertrophic cardiomyopathy. J Am Coll Cardiol 1999, 33:2044–2051.
Maron BJ, Cecchi F, McKenna WJ: Risk factors and stratification for sudden cardiac death in patients with hypertrophic cardiomyopathy. Br Heart J 1994, 72:S13-S18.
McKenna WJ, Sadoul N, Slade AKB, Saumarez RC: The prognostic significance of nonsustained ventricular tachycardia in hypertrophic cardiomyopathy. Circulation 1994, 90:3115–3117.
Clark CE, Henry WL, Epstein SE: Familial prevalence and genetic transmission if idiopathic hypertrophic subaortic stenosis. N Engl J Med 1973, 289:709–714.
van DorpWG, ten Cate FJ, Vletter WB, et al.: Familial prevalence of asymmetric septal hypertrophy. Eur J Cardiol 1976, 4:349–357.
Jarcho JA, McKenna W, Pare JA, et al.: Mapping a gene for familial hypertrophic cardiomyopathy to chromosome 14q1. N Engl J Med 1989, 321:1372–1378.
Maron BJ, Isner JM, McKenna WJ: Task Force 3: Hypertrophic cardiomyopathy, myocarditis and other myopericardial diseases and mitral valve prolapse. J Am Coll Cardiol 1994, 24:880–882. Guidelines for the evaluation and assessment of risk in athletes with HCM. This report from the AHA includes the current recommendations for participation in competitive sports in athletes with this condition.
Chang AC, McAreavey D, Fananapzir L: Identification of patients with hypertrophic cardiomyopathy at high risk for sudden death. Curr Opin Cardiol 1995, 10:9–15.
Pelliccia A, Maron BJ, Spataro A, et al.: The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 1991, 324:295–301.
Lewis JF, Maron BJ, Diggs JA, et al.: Preparticipation echocardiographic screening for cardiovascular disease in a large, predominantly black population of collegiate athletes. Am J Cardiol 1989, 64:1029–1033.
Maron BJ, Bodison SA, Wesley YE, et al.: Results of screening a large group of intercollegiate competitive athletes for cardiovascular disease. J Am Coll Cardiol 1987, 10:1214–1221.
Maron BJ, Thompson PD, Puffer JC, et al.: Cardiovascular preparticipation screening of competitive athletes: an addendum to a statement for health professionals from the Sudden Death Committee (Council on Clinical Cardiology) and the Congenital Cardiac Defects Committee (Council on Cardiovascular Disease in the Young), American Heart Association. Circulation 1998, 97:2294.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rizvi, A.A., Thompson, P.D. Hypertrophic cardiomyopathy: Who plays and who sits. Curr Sports Med Rep 1, 93–99 (2002). https://doi.org/10.1007/s11932-002-0056-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11932-002-0056-0