Hypertrophic Cardiomyopathy: Updates Through the Lens of Sports Cardiology

Abstract

Purpose of review This review will summarize the distinction between hypertrophic cardiomyopathy (HCM) and exercise-induced cardiac remodeling (EICR), describe treatments of particular relevance to athletes with HCM, and highlight the evolution of recommendations for exercise and competitive sport participation relevant to individuals with HCM. Recent findings Whereas prior guidelines have excluded individuals with HCM from more than mild-intensity exercise, recent data show that moderate-intensity exercise improves functional capacity and indices of cardiac function and continuation of competitive sports may not be associated with worse outcomes. Moreover, recent studies of athletes with implantable cardioverter defibrillators (ICDs) demonstrated a safer profile than previously understood. In this context, the updated American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) HCM guidelines have increased focus on shared decision-making and liberalized restrictions on exercise and sport participation among individuals with HCM. Summary New data demonstrating the safety of exercise in individuals with HCM and in athletes with ICDs, in addition to a focus on shared decision-making, have led to the most updated guidelines easing restrictions on exercise and competitive athletics in this population. Further athlete-specific studies of HCM, especially in the context of emerging therapies such as mavacamten, are important to inform accurate risk stratification and eligibility recommendations.

Hypertrophic cardiomyopathy and competitive sports: let ‘em play?

“…Around two-thirds of SCA in younger individuals with HCM occurred during routine activities, sedentary activities, or sleep [22] rather than exercise. For patients with HCM, there are many factors that may limit exercise tolerance and include outflow tract obstruction, diastolic dysfunction, abnormal hemodynamic response (particularly blood pressure) to exercise, predisposition to atrial and ventricular arrhythmias (most notably atrial fibrillation) and myocardial ischemia [23].…”