New Insights and Recommendations for Athletes With Hypertrophic Cardiomyopathy

ABSTRACT

Hypertrophic cardiomyopathy (HCM) has long been considered a high-risk cardiac condition for which exercise was felt to increase the risk of sudden cardiac death (SCD). This was founded in part by initial autopsy studies reporting HCM to be a leading medical cause of SCD amongst young athletes. Most forms of competitive sport and exercise were therefore believed to increase the risk of SCD to a prohibitive level. Resultant expert consensus guideline recommendations universally restricted athletes with HCM from participation in moderate-to-vigorous intensity sport and exercise in a binary "yes" or "no" clinical decision-making process with the goal of reducing the risk of sports related SCD. HCM is, however, a heterogenous genetic condition with variable penetrance and risk. The degree to which sports and exercise increases the risk of SCD at an individual patient level continues to be area of clinical uncertainty. Emerging data and clinical experience from the last several decades have provided important new insights into exercise related risks and have drawn into question the appropriateness of overly restrictive binary clinical decision-making for exercise recommendations in HCM. This includes an improved understanding of the overall prevalence of HCM in the general population, improved observational estimates of the risk of SCD related to continued sport and exercise participation, and a general shift towards improved patient centered approaches to care through shared decision-making processes. The rules by which the game is played may be changing for athletes with HCM.