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Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review.

Drezner, JA; Malhotra, A; Prutkin, JM; Papadakis, M; Harmon, KG; Asif, IM; Owens, DS; Marek, JC; Sharma, S (2021) Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review. Br J Sports Med, 55 (18). pp. 10041-1047. ISSN 1473-0480 https://doi.org/10.1136/bjsports-2020-102921
SGUL Authors: Sharma, Sanjay Malhotra, Aneil

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Abstract

The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the 'blanket' disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree.

Item Type: Article
Additional Information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: cardiovascular, death, heart disease, prevention, sport, Sport Sciences, 11 Medical and Health Sciences, 09 Engineering, 13 Education
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Br J Sports Med
ISSN: 1473-0480
Language: eng
Dates:
DateEvent
1 September 2021Published
20 January 2021Published Online
3 December 2020Accepted
PubMed ID: 33472848
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112843
Publisher's version: https://doi.org/10.1136/bjsports-2020-102921

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