Does Sport Participation Worsen the Clinical Course of Hypertrophic Cardiomyopathy?
2018; Lippincott Williams & Wilkins; Volume: 137; Issue: 5 Linguagem: Inglês
10.1161/circulationaha.117.031725
ISSN1524-4539
AutoresAntonio Pelliccia, Erika Lemme, Viviana Maestrini, Fernando M. Di Paolo, Cataldo Pisicchio, Giuseppe Di Gioia, Stefano Caselli,
Tópico(s)Cardiac Arrhythmias and Treatments
ResumoHomeCirculationVol. 137, No. 5Does Sport Participation Worsen the Clinical Course of Hypertrophic Cardiomyopathy? Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBDoes Sport Participation Worsen the Clinical Course of Hypertrophic Cardiomyopathy?Clinical Outcome of Hypertrophic Cardiomyopathy in Athletes Antonio Pelliccia, MD, Erika Lemme, MD, Viviana Maestrini, MD, Fernando M. Di Paolo, MD, Cataldo Pisicchio, MD, Giuseppe Di Gioia, MD and Stefano Caselli, MD Antonio PellicciaAntonio Pelliccia Institute of Sport Medicine and Science, Rome, Italy. Search for more papers by this author , Erika LemmeErika Lemme Institute of Sport Medicine and Science, Rome, Italy. Search for more papers by this author , Viviana MaestriniViviana Maestrini Institute of Sport Medicine and Science, Rome, Italy. Search for more papers by this author , Fernando M. Di PaoloFernando M. Di Paolo Institute of Sport Medicine and Science, Rome, Italy. Search for more papers by this author , Cataldo PisicchioCataldo Pisicchio Institute of Sport Medicine and Science, Rome, Italy. Search for more papers by this author , Giuseppe Di GioiaGiuseppe Di Gioia Institute of Sport Medicine and Science, Rome, Italy. Search for more papers by this author and Stefano CaselliStefano Caselli Institute of Sport Medicine and Science, Rome, Italy. Search for more papers by this author Originally published30 Jan 2018https://doi.org/10.1161/CIRCULATIONAHA.117.031725Circulation. 2018;137:531–533Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease with respect to its clinical expression and natural history, with sudden cardiac death (SCD) representing the most devastating complication in young people, including athletes.1 At present, guidelines recommend precautionary disqualification from competitive sports in individuals with HCM, regardless of the absence of major risks for SCD.2,3 However, the impact of sport participation on the clinical outcome of HCM has been poorly investigated.To address this question, we assessed the clinical course of a selected cohort of patients with HCM, in relation with their continued or dismissed participation in exercise training and sport competition.Thirty-five athletes consecutively examined in our institute from 1996 to 2016 with a definitive diagnosis of HCM1–3 were included in the present analysis: mostly males (n= 33), whites (n =33), and 32±13 (14–53) years of age. Athletes participated in soccer (n =13), athletics (n =6), rowing, swimming, basketball, triathlon, tennis, cycling (each, n =2), and water polo, volleyball, handball, and dance (each, n =1). Each had been engaged in training and competitions for 5 to 31 years (mean 15±8). Level of achievement included elite/international (n =3), national (n =10), and regional/county tournaments (n =22).The risk profile of the athletes with HCM was assessed according to European Society of Cardiology and American Heart Association algorithms.4,5 According to the European Society of Cardiology, the vast majority (n = 31, 88%) was at low risk (ie, 6 hours/week) and sport competitions and 6 in amateur or leisure-time athletic activities (<6 hours/week).Over the follow-up, 1 event occurred (incidence 0.3% per year): an amateur tennis player incurred an abrupt cardiac arrest while walking in an urban shopping area. Prompt cardiopulmonary resuscitation and availability of automated external defibrillator (which showed ventricular fibrillation) resulted in a successful defibrillation. Coronary angiography excluded significant atherosclerotic lesions, and the athlete had ICD implanted in secondary prevention. Seven other athletes reported incidence of symptoms (ie, 2.2% per year): 3 experienced syncope, 4 palpitations identified at 24-hour ECG monitoring as bursts of nonsustained ventricular tachycardia in 2, and frequent ventricular ectopic beats in 2.The incidence of combined event and symptoms was not different among individuals who continued exercise and sport programs (3 out of 15) versus those who dismissed any physical activity (5 out of 20; log-rank test P=0.236; Cox regression analysis hazard ratio = 2.4; 95% confidence interval, 0.5–11.1; P=0.255). Kaplan-Meier event/symptoms-free survival curves are shown in the Figure.Download figureDownload PowerPointFigure. Kaplan-Meier analysis of survival-free from event/symptoms in athletes with HCM over the follow-up, according to their participation in regular exercise programs and sport competitions. HCM indicates hypertrophic cardiomyopathy.Patients experiencing event or symptoms presented positive family history for HCM in larger proportion (63% versus 11%, P<0.002), had more frequent bursts of NSVT at 24-hour ECG monitoring (38% versus 7%, P<0.03), had a higher rate of positive late gadolinium enhancement on cardiac magnetic resonance (67% versus 18%, P<0.02), and lower e’ velocity on tissue Doppler echocardiography (5.5±1.7 versus 9.2±3.2, P<0.02).The athletes with HCM included in this study represent a selected subset of patients with HCM, mostly characterized by low risk (ie, 89% according to the European Society of Cardiology, 77% according to the American Heart Association)4,5 and none with indication for prophylactic ICD implant. We guessed a benign clinical outcome, in consideration of the absence of major risks for SCD, mild morphological and functional abnormalities, and excellent cardiac performance.Nevertheless, no differences with regard to incidence of symptoms and event were observed among patients who dismissed or continued their exercise programs and sport competitions. Regardless of athletic or sedentary lifestyle, a substantial subset of patients (20%) developed symptoms during follow-up (ie, 2.2% per year). Indeed, we registered 1 cardiac event, out of the athletic context, consistent with an incidence of 0.3% per year.In conclusion, this study shows that over a period of 9-year follow-up, even low-risk athletes with HCM may incur symptoms (2.2% per year) and cardiac arrest (0.3% per year) but suggests that the incidence of event/symptoms is largely independent from continuation or interruption of regular exercise and sport programs. Further studies, comprising a larger population of athletes with HCM followed for a substantial period of time are needed to substantiate our preliminary observations.Antonio Pelliccia, MDErika Lemme, MDViviana Maestrini, MDFernando M. Di Paolo, MDCataldo Pisicchio, MDGiuseppe Di Gioia, MDStefano Caselli, MDSources of FundingThis work was funded by the Italian Olympic Committee.DisclosuresNone.FootnotesThe data, analytic methods, and study materials will be available on request to other researchers for purposes of reproducing the results or replicating the procedure.Circulation is available at http://circ.ahajournals.org.Correspondence to: Antonio Pelliccia, MD, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome 00197, Italy. E-mail [email protected]References1. Maron BJ, Maron MS. Hypertrophic cardiomyopathy.Lancet. 2013; 381:242–255. doi: 10.1016/S0140-6736(12)60397-3.CrossrefMedlineGoogle Scholar2. 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Rajtar-Salwa R and Dimitrow P (2018) Letter by Rajtar-Salwa and Dimitrow Regarding Article, “Exercise and Hypertrophic Cardiomyopathy: Time for a Change of Heart”, Circulation, 138:3, (331-332), Online publication date: 17-Jul-2018. January 30, 2018Vol 137, Issue 5 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.117.031725PMID: 29378761 Originally publishedJanuary 30, 2018 Keywordshypertrophic cardiomyopathysport participationPDF download Advertisement
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