Newman Darrell B, Garmany Ramin, Contreras Alejandra Meza, Bos J Martijn, Johnson Jonathan N, Geske Jeffrey B, Allison Thomas G, Ommen Steve R, Ackerman Michael J
Department of Cardiovascular Medicine.
Mayo Clinic Medical Scientist Training Program, Mayo Clinic Alix School of Medicine, Rochester, Minnesota; Department of Molecular Pharmacology & Experimental Therapeutics/Windland Smith Rice Sudden Death Genomics Laboratory.
Am J Cardiol. 2023 Feb 15;189:49-55. doi: 10.1016/j.amjcard.2022.11.008. Epub 2022 Dec 9.
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 VO) of 37.9 ml/min/kg (83% of predicted peak VO). 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 VO 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.
肥厚型心肌病（HCM）患者历来因被认为存在心源性猝死风险而被限制参加体育活动。更多当代研究强调了HCM患者参加竞技运动的相对安全性。然而，缺乏关于心肺运动试验（CPET）参考值的已发表数据，这使得个体运动员的临床管理和运动参与咨询变得复杂。我们进行了一项单中心回顾性队列研究，以调查HCM运动员的CPET以及与有氧能力客观指标相关的临床特征。我们确定了58例HCM运动员（74%为男性，平均年龄18±3岁，平均左心室（LV）壁厚度20±7mm）。22例（38%）存在左心室流出道梗阻。共有15例（26%）运动员正在服用β受体阻滞剂（BB），但只有4例（7%）报告有劳力性症状。总体而言，运动能力轻度降低，心肌耗氧量峰值（峰值VO）为37.9ml/min/kg（预测峰值VO的83%）。左心室流出道梗阻和使用BB均与运动能力降低有关。有限的峰值心率在服用BB的运动员中更常见（47%对9%，p = 0.002）。在平均5.6年的随访中，5例患者接受了心肌切除术（9%），8例（14%）接受了植入式心律转复除颤器（ICD）进行一级预防。1例左心室巨大肥厚患者因室颤经历了反复的ICD电击，并在初次评估7年后接受了心肌切除术，不再参加体育活动。随访期间无死亡病例。总之，CPET在HCM运动员中的预后作用仍不明确。运动能力轻度降低很常见；然而，峰值VO降低与症状状态或临床结局无关。相当一部分患者后来需要进行心肌切除术和/或植入ICD，因此突出了密切随访的必要性。这些数据为“现实世界”中HCM运动员的临床评估提供了一些初步见解；然而，有必要进行进一步研究，以帮助指导共同决策、恢复运动讨论以及竞技运动参与的潜在长期安全性。
