Patients with hypertrophic cardiomyopathy (HCM) have historically been restricted
from athletic participation because of the perceived risk of sudden cardiac death.
More contemporary research has highlighted the relative safety of competitive athletics
with HCM. However, lack of published data on reference values for cardiopulmonary
exercise testing (CPET) complicates clinical management and counseling on sports participation
in the individual athlete. We conducted a single-center, retrospective cohort study
to investigate CPET in athletes with HCM and clinical characteristics associated with
objective measures of aerobic capacity. We identified 58 athletes with HCM (74% male,
mean age 18 ± 3 years, mean left ventricular (LV) wall thickness 20 ± 7 mm). LV outflow
tract obstruction was present in 22 (38%). A total of 15 (26%) athletes were taking
a β blocker (BB), but only 4 (7%) reported exertional symptoms. Overall, exercise
capacity was mildly reduced, with a peak myocardial oxygen consumption (peak VO2) of 37.9 ml/min/kg (83% of predicted peak VO2). Both LV outflow tract obstruction and BB use were associated with reduced exercise
capacity. Limited peak heart rate was more common in athletes taking BB (47% vs 9%,
p = 0.002). At a mean 5.6 years follow-up, 5 patients underwent myectomy (9%), and
8 (14%) received an implantable cardioverter defibrillator (ICD) for primary prevention.
One individual with massive LV hypertrophy experienced recurrent ICD shocks for ventricular
fibrillation and underwent myectomy 7 years after initial evaluation and was no longer
participating in sports. There were no deaths over the follow-up period. In conclusion,
the prognostic role of CPET remains unclear in athletes with HCM. Mildly reduced exercise
capacity was common; however, reduced peak VO2 did not correlate with symptom status or clinical outcomes. A significant proportion
went on to require myectomy and/or ICD, thus highlighting the need for close follow-up.
These data provide some initial insight into the clinical evaluation of “real world”
athletes with HCM; however, further study is warranted to help guide shared decision-making,
return-to-play discussions, and the potential long-term safety of competitive athletic
participation.
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Article info
Publication history
Published online: December 09, 2022
Received in revised form:
October 7,
2022
Received:
August 30,
2022
Footnotes
Dr. Newman and Mr. Garmany contributed equally to this manuscript.
Funding: none.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
