See Clinical Perspective

Background—The phenotype of individuals with hypertrophic cardiomyopathy (HCM) who exercise regularly is unknown. This study characterized the clinical profile of young athletes with HCM. Methods and Results—The electrical, structural, and functional cardiac parameters from 106 young (14–35 years) athletes with HCM were compared with 101 sedentary HCM patients. A subset of athletes with HCM exhibiting morphologically mild (13–16 mm), concentric disease was compared with 55 healthy athletes with mild physiological left ventricular hypertrophy (LVH). Most athletes with HCM (96%) exhibited T-wave inversion and had milder LVH (15.8±3.4 mm versus 19.7±6.5 mm, P<0.001), larger left ventricular cavity dimensions (47.8±6.0 mm versus 44.3±7.7 mm, P<0.001), and superior indices of diastolic function (average E/E′ 7.9±2.4 versus 10.7±3.9, P<0.001) compared with sedentary HCM patients. In athletes with HCM, LVH was frequently (36%) confined to the apex and only 15 individuals (14%) exhibited mild concentric LVH mimicking physiological LVH. In these 15 athletes, conventional structural and functional cardiac parameters showed modest sensitivity and specificity for differentiating HCM from physiological LVH: 13% had a left ventricular cavity >54 mm, 87% had a left atrium ⩽40, and 100% had an E/E′ <12. Conclusions—Athletes with HCM exhibit less LVH, larger left ventricular cavities, and normal indices of diastolic function compared with sedentary patients. Only a minority of athletes with HCM constitute the conventional gray zone of mild, concentric LVH. In this minority, conventional echocardiographic parameters alone are insufficient to differentiate HCM from physiological LVH and should be complemented by additional structural and functional assessments to minimize the risk of false reassurance.

[1]  E. Donal,et al.  Recognition and Significance of Pathological T-Wave Inversions in Athletes , 2015, Circulation.

[2]  B. Maron,et al.  Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. , 2014, The American journal of cardiology.

[3]  F. Rutten,et al.  2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). , 2014, European heart journal.

[4]  Mathew G. Wilson,et al.  Comparison of Electrocardiographic Criteria for the Detection of Cardiac Abnormalities in Elite Black and White Athletes , 2014, Circulation.

[5]  Reza Razavi,et al.  Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy. , 2013, JACC. Cardiovascular imaging.

[6]  Barry J Maron,et al.  2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines , 2011, Circulation.

[7]  Barry J Maron,et al.  2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Soci , 2011, Journal of the American College of Cardiology.

[8]  Mathew G. Wilson,et al.  Hypertrophic cardiomyopathy and ultra-endurance running - two incompatible entities? , 2011, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[9]  G. Kervio,et al.  The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. , 2011, European heart journal.

[10]  Kenneth A Ellenbogen,et al.  2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2011, Journal of the American College of Cardiology.

[11]  Barry J Maron,et al.  Recommendations for interpretation of 12-lead electrocardiogram in the athlete. , 2009, European heart journal.

[12]  R. Shephard.  Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006 , 2010 .

[13]  S. Raman,et al.  Influence of Myocardial Fibrosis on Left Ventricular Diastolic Function: Noninvasive Assessment by Cardiac Magnetic Resonance and Echo , 2009, Circulation. Cardiovascular imaging.

[14]  B. Maron,et al.  Distinguishing hypertrophic cardiomyopathy from athlete’s heart physiological remodelling: clinical significance, diagnostic strategies and implications for preparticipation screening , 2009, British Journal of Sports Medicine.

[15]  F. Flachskampf,et al.  Recommendations for the evaluation of left ventricular diastolic function by echocardiography. , 2008, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[16]  R. Shephard,et al.  Ethnic Differences in Left Ventricular Remodeling in Highly-Trained Athletes: Relevance to Differentiating Physiologic Left Ventricular Hypertrophy From Hypertrophic Cardiomyopathy , 2009 .

[17]  G. Whyte,et al.  Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening. , 2008, Journal of the American College of Cardiology.

[18]  Barry J Maron,et al.  The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. , 2006, Circulation.

[19]  G. Whyte,et al.  Physiological left ventricular hypertrophy or hypertrophic cardiomyopathy in an elite adolescent athlete: role of detraining in resolving the clinical dilemma , 2006, British Journal of Sports Medicine.

[20]  W. Manning,et al.  Prevalence, Clinical Profile, and Significance of Left Ventricular Remodeling in the End-Stage Phase of Hypertrophic Cardiomyopathy , 2006, Circulation.

[21]  Richard B Devereux,et al.  Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardio , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[22]  B. Maron,et al.  Pitfalls in the echocardiographic diagnosis of isolated non-compaction of the ventricular myocardium , 2005, Heart.

[23]  M. Quiñones,et al.  Tissue Doppler Imaging Predicts the Development of Hypertrophic Cardiomyopathy in Subjects With Subclinical Disease , 2003, Circulation.

[24]  Wilfried Kindermann,et al.  Athlete's heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. , 2002, Journal of the American College of Cardiology.

[25]  C. Otto,et al.  Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[26]  A. Fraser,et al.  Differentiation between pathologic and physiologic left ventricular hypertrophy by tissue Doppler assessment of long-axis function in patients with hypertrophic cardiomyopathy or systemic hypertension and in athletes. , 2001, The American journal of cardiology.

[27]  W. Mckenna,et al.  Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes. , 2000, Journal of the American College of Cardiology.

[28]  W. Mckenna,et al.  Utility of cardiopulmonary exercise in the assessment of clinical determinants of functional capacity in hypertrophic cardiomyopathy. , 2000, The American journal of cardiology.

[29]  I. Belenkie,et al.  Exercise capacity in hypertrophic cardiomyopathy. Role of stroke volume limitation, heart rate, and diastolic filling characteristics. , 1995, Circulation.

[30]  B. Maron,et al.  Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete's heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. , 1995, Circulation.

[31]  B. Maron,et al.  Surviving competitive athletics with hypertrophic cardiomyopathy. , 1994, The American journal of cardiology.

[32]  B. Maron,et al.  Usefulness of Doppler echocardiographic assessment of diastolic filling in distinguishing “athlete's heart” from hypertrophic cardiomyopathy , 1992, British heart journal.

[33]  M. Frenneaux,et al.  Mechanisms of exercise limitation in hypertrophic cardiomyopathy. , 1992, Journal of the American College of Cardiology.

[34]  M. Proschan,et al.  The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. , 1991, The New England journal of medicine.

[35]  R. Bonow,et al.  Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (1). , 1987, The New England journal of medicine.

[36]  R. Bonow,et al.  Hypertrophic cardiomyopathy. , 1987, Disease-a-month : DM.

[37]  Youshouzhai Gu.  Echo , 1980, The Craft of Poetry.