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Specific Cardiovascular Diseases and Competitive Sports Participation: Hypertrophic Cardiomyopathy

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Textbook of Sports and Exercise Cardiology

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Abstract

Participation in high intensity athletic training is associated with increased cardiac size and mass in response to the increased loading conditions. In the majority of athletes, these changes are modest, but in a smaller percentage of individuals they may be more substantial, rising the differential diagnosis with structural heart disease. Specifically, 2% to 4% of white athletes and up to 12% of black athletes may present on cardiac imaging with a left ventricular wall thickness between 13 and 15 mm, which identifies the “gray zone” in which the differential diagnosis with hypertrophic cardiomyopathy (HCM) may be challenging. However, this distinction is extremely important, as HCM is associated with an increased risk to exercise related sudden deaths in young competitive athletes. Affected individuals should therefore correctly be identified in order to provide appropriate indication to sport participation. A multimodality approach including clinical information, ECG interpretation and cardiovascular imaging usually provide important clues for this differential diagnosis and for prognostic stratification.

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Author information

Authors and Affiliations

  1. Department of Medicine, Institute of Sports Medicine and Science, Rome, Italy

    Antonio Pelliccia

  2. Cardiovascular Center Zurich, Hirslanden Klinik im Park, Zurich, Switzerland

    Stefano Caselli

Authors
  1. Antonio Pelliccia
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  2. Stefano Caselli
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Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    In the presence of infero-lateral T waves, is a normal echocardiography enough or should the athlete undergo cardiac magnetic resonance?

  2. 2.

    Is left atrial dilatation a marker of HCM?

  3. 3.

    Should HCM individuals avoid any sport activity?

1.2 Answers

  1. 1.

    Infero-lateral negative T waves are uncommon in athletes and a likely expression of a structural cardiovascular disease and most common HCM. Therefore, it is advised that a CMR is performed in order to exclude small areas of focal hypertrophy or fibrosis.

  2. 2.

    No. Left atrial enlargement has been described in athletes as an expression of global cardiac adaptation to training and is typically associated with increased LV size. Therefore, dilated left atrium is not a specific sign of HCM.

  3. 3.

    Competitive sports are not recommended by the current guidelines. A tailored non-competitive exercise program may be recommended based on careful assessment of risk profile.

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Pelliccia, A., Caselli, S. (2020). Specific Cardiovascular Diseases and Competitive Sports Participation: Hypertrophic Cardiomyopathy. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_13

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  • DOI: https://doi.org/10.1007/978-3-030-35374-2_13

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  • Online ISBN: 978-3-030-35374-2

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