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Clinical outcomes in adult athletes with hypertrophic cardiomyopathy: a 7-year follow-up study
  1. Antonio Pelliccia1,
  2. Stefano Caselli1,
  3. Matteo Pelliccia2,
  4. Maria Beatrice Musumeci2,
  5. Erika Lemme1,
  6. Fernando M Di Paolo1,
  7. Viviana Maestrini1,
  8. Domitilla Russo2,
  9. Luca Limite2,
  10. Cristian Borrazzo3,
  11. Camillo Autore2
  1. 1 Department of Medicine, Institute of Sports Medicine and Science, Rome, Italy
  2. 2 Departement of Medicine, Azienda Ospedaliera Sant Andrea, Roma, Lazio, Italy
  3. 3 Department of Public Health and Infectious Disease, Sapienza University of Rome, Roma, Lazio, Italy
  1. Correspondence to Dr Antonio Pelliccia, Cardiology, Institute of Sports Medicine and Science, Rome 00197, Italy; ant.pelliccia{at}


Objective Current guidelines recommend precautionary disqualification from competitive sports in patients with hypertrophic cardiomyopathy (HCM). We assessed the incidence of cardiovascular events in a cohort of patients with HCM engaged in long-term exercise programmes and competitive sport.

Methods We reviewed data on 88 consecutive athletes diagnosed with HCM, from 1997 to 2017; 92% male, 98% Caucasian, median age 31 (IQR: 19–44) years. All participated in regular exercise programmes and competitive sport at study entry.

We performed follow-up evaluation after 7±5 (1–21) years. 61 (69%) of the athletes had substantially reduced or stopped exercise and sport (ie, HCM-detrained), and 27 had continued with regular training and sport competitions (HCM-trained). At baseline evaluation, both groups were similar for age, gender balance, symptoms, ECG abnormalities, extent of left ventricular hypertrophy, arrhythmias and risk profile for sudden cardiac death/arrest.

Results During the follow-up period, two participants suffered sudden cardiac arrest or death (0.3% per year) both outside of sport participation. In addition, 19 (22%) reported symptoms (syncope in 3, palpitations in 10, chest pain in 4 and dyspnoea in 2). The Kaplan-Meier analyses of freedom from combined sudden cardiac arrest/death and symptoms (log-rank test p=0.264) showed no differences between HCM-trained and detrained patients.

Conclusion In this adult cohort of low-risk HCM athletes, voluntary decision to pursue in participation in competitive sport events was not associated with increased risk for major cardiac events or clinical worsening compared with decision to reduce or withdraw from exercise programmes and sport. Similar results may not be seen in younger or racially diverse athlete populations, or in patients with more severe HCM phenotypes.

  • athlete
  • cardiology
  • cardiovascular
  • heart disease

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  • Contributors Each of the authors had a substantial part in the planning of the study, collecting data, interpreting results, writing and revising the manuscript. Specifically, planning the study project: AP, SC, CA. Collecting data: EL, MP, DR, LL, FMDP. Interpreting data: AP, SC, CA, EL, MBM, VM, CB. Statistical analysis: CB. Manuscript writing and revising: AP, SC, CA, CB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The plan of the study was evaluated and approved by the internal Review Board of the Institute of Sport Medicine and Science. The research was done without patient involvement. Patients were not invited to comment on the study design and were not consulted to develop patient relevant outcomes or interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All clinical data assembled from athletes included in this study are maintained in the institutional database of the participating institutions.