Clinical profile of athletes with hypertrophic cardiomyopathy

Nabeel Sheikh, Michael Papadakis, Frédéric Schnell, Vasileios F. Panoulas, Aneil Malhotra, Mathew Wilson, François Carré, Sanjay Sharma

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere003454
Pages (from-to)1-9
Number of pages11
JournalCirculation: Cardiovascular Imaging
Volume8
Issue number7
DOIs
Publication statusPublished - 1 May 2015
Externally publishedYes

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Hypertrophic Cardiomyopathy
Athletes
Left Ventricular Hypertrophy
Exercise
Phenotype

Cite this

Sheikh, N., Papadakis, M., Schnell, F., Panoulas, V. F., Malhotra, A., Wilson, M., ... Sharma, S. (2015). Clinical profile of athletes with hypertrophic cardiomyopathy. Circulation: Cardiovascular Imaging, 8(7), 1-9. [e003454]. https://doi.org/10.1161/CIRCIMAGING.114.003454
Sheikh, Nabeel ; Papadakis, Michael ; Schnell, Frédéric ; Panoulas, Vasileios F. ; Malhotra, Aneil ; Wilson, Mathew ; Carré, François ; Sharma, Sanjay. / Clinical profile of athletes with hypertrophic cardiomyopathy. In: Circulation: Cardiovascular Imaging. 2015 ; Vol. 8, No. 7. pp. 1-9.
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abstract = "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.",
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Sheikh, N, Papadakis, M, Schnell, F, Panoulas, VF, Malhotra, A, Wilson, M, Carré, F & Sharma, S 2015, 'Clinical profile of athletes with hypertrophic cardiomyopathy', Circulation: Cardiovascular Imaging, vol. 8, no. 7, e003454, pp. 1-9. https://doi.org/10.1161/CIRCIMAGING.114.003454

Clinical profile of athletes with hypertrophic cardiomyopathy. / Sheikh, Nabeel; Papadakis, Michael; Schnell, Frédéric; Panoulas, Vasileios F.; Malhotra, Aneil; Wilson, Mathew; Carré, François; Sharma, Sanjay.

In: Circulation: Cardiovascular Imaging, Vol. 8, No. 7, e003454, 01.05.2015, p. 1-9.

Research output: Contribution to journalArticle

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T1 - Clinical profile of athletes with hypertrophic cardiomyopathy

AU - Sheikh, Nabeel

AU - Papadakis, Michael

AU - Schnell, Frédéric

AU - Panoulas, Vasileios F.

AU - Malhotra, Aneil

AU - Wilson, Mathew

AU - Carré, François

AU - Sharma, Sanjay

N1 - © 2015 American Heart Association, Inc.

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N2 - 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.

AB - 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.

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KW - Male

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KW - Female

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KW - Diagnosis, Differential

KW - Logistic Models

KW - Cardiomyopathy, Hypertrophic/diagnosis

KW - Athletes

KW - Chi-Square Distribution

KW - Hypertrophy, Left Ventricular/diagnosis

KW - Stroke Volume

KW - Cardiomegaly, Exercise-Induced

KW - Phenotype

KW - Adolescent

KW - London

KW - Sedentary Behavior

KW - exercise physiology

KW - echocardiography

KW - primary prevention

KW - left ventricular hypertrophy

KW - hypertrophic cardiomyopathy

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Sheikh N, Papadakis M, Schnell F, Panoulas VF, Malhotra A, Wilson M et al. Clinical profile of athletes with hypertrophic cardiomyopathy. Circulation: Cardiovascular Imaging. 2015 May 1;8(7):1-9. e003454. https://doi.org/10.1161/CIRCIMAGING.114.003454