Sports participation in non-compaction cardiomyopathy: a systematic review

Abstract

Non-compaction cardiomyopathy (NCCM) is typified by deep invaginations of the myocardium and is caused by an arrest of normal myocardial morphogenesis. NCCM was once considered rare, but is now widely recognised owing to frequent use of advanced imaging techniques. NCCM can also be detected when competitive athletes undergo preparticipation screening for cardiac disease or when being evaluated for cardiac symptoms. It is not clear how athletes with NCCM should be managed. We searched PubMed and Google for articles addressing the issue of NCCM and athletic participation. We were able to identify only 18 cases of NCCM described in the context of sports, athletics or exercise. We conclude that there are insufficient data to develop firm recommendations on how to manage vigorous activity in patients with NCCM and future registries of sudden death in athletes should include a careful search for cases of NCCM among the victims so that clinicians can develop more definitive recommendations for athletes with this condition.

European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart

“…175 The clinical diagnosis is currently reliant on three proposed echocardiographic criteria and are based on the demonstration of high non-compacted to compacted ratio within the LV myocardium. 173,174,177 Advances in tissue harmonics and image resolution in echocardiography have coincided with increased reports of features consistent with LVNC in patients with heart failure, 176 as well as in low-risk cohorts including sickle cell patients 178 and athletes, [179][180][181][182][183][184] particularly those of African/Afro-Caribbean origin. A study of over a 1000 asymptomatic athletes demonstrated that 18% exhibited increased LV trabeculations and 8% fulfilled echocardiographic criteria for LVNC, more commonly in black athletes.…”

The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019

“…Neither the extent to which physical training can alter non-compacted cardiomyopathy nor the prevalence of non-compacted LV morphology among healthy athletes have been determined. 151 , 152 Since forensic reports of SD in young athletes do not include non-compacted cardiomyopathy as a possible cause, it is not possible to apply risk stratification strategies for new patients with this disease.…”

Cardiovascular Magnetic Resonance and Sport Cardiology: a Growing Role in Clinical Dilemmas

“…The electrocardiogram (ECG) in LVNC is abnormal in up to 87% of cases but variable, with no definitive criteria. The most common ECG finding in athletes with LVNC is LVH by voltage criteria [68], with other arrhythmias detected on Holter or stress testing, all non-specific findings. LGE if present is supportive of myopathy and relates to adverse clinical features, but both athletes and LVNC may have no LGE so sensitivity is low [69].…”