Clinical Research
Cardiomyopathy
Prevalence of Hypertrophic Cardiomyopathy in Highly Trained Athletes: Relevance to Pre-Participation Screening

https://doi.org/10.1016/j.jacc.2007.10.055Get rights and content
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Objectives

This study sought to determine the prevalence of hypertrophic cardiomyopathy (HCM) in elite athletes.

Background

Hypertrophic cardiomyopathy is considered to be the most common cause of exercise-related sudden death in young athletes. The prevalence of HCM in elite athletes has never been reported but has important implications with regard to pre-participation screening for the disorder.

Methods

Between 1996 and 2006, 3,500 asymptomatic elite athletes (75% male) with a mean age of 20.5 ± 5.8 years (range 14 to 35 years) underwent 12-lead electrocardiography and 2-dimensional echocardiography. None had a known family history of HCM.

Results

Of the 3,500 athletes, 53 (1.5%) had left ventricular hypertrophy (mean 13.6 ± 0.9, range 13 to 16), and of these 50 had a dilated left ventricular cavity with normal diastolic function to indicate physiological left ventricular hypertrophy. Three (0.08%) athletes with left ventricular hypertrophy had a nondilated left ventricular cavity and associated deep T-wave inversion that could have been consistent with HCM. However, none of the 3 athletes had any other phenotypic features of HCM on further noninvasive testing and none had first-degree relatives with features of HCM. One of the 3 athletes agreed to detrain for 12 weeks, which showed resolution of electrocardiography and echocardiographic changes confirming physiologic left ventricular hypertrophy.

Conclusions

The prevalence of HCM in highly trained athletes is extremely rare. Structural and functional changes associated with HCM naturally select out most individuals from competitive sports. Screening athletes with echocardiography is not cost effective. However, electrocardiography is useful in selecting out those individuals who may have pathological left ventricular hypertrophy for subsequent echocardiography.

Abbreviations and Acronyms

ECG
electrocardiography
HCM
hypertrophic cardiomyopathy
LV
left ventricle/ventricular
LVH
left ventricular hypertrophy
SCD
sudden cardiac death

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Dr. Basavarajaiah is supported by a junior cardiac research fellow grant from the charity organization Cardiac Risk in the Young.