Are athletes more likely to have Hypertrophic Obstructive Cardiomyopathy (HOCM) than the general population?

From the Guidelines

Athletes are more likely to have Hypertrophic Obstructive Cardiomyopathy (HOCM) diagnosed due to increased screening and surveillance, but the actual prevalence of HOCM in athletes is not significantly higher than in the general population.

Key Points

• HOCM is a common cause of sudden cardiac death (SCD) in young athletes, accounting for approximately one third of cases 1.
• The prevalence of HOCM in the general population is estimated to be around 1:500 1.
• Athletes with HOCM are at increased risk of SCD, particularly during intense competitive sports 1.
• Participation in high-intensity competitive sports itself has been considered as an independent risk factor for SCD/CA, even in the absence of conventional risk markers 1.
• The incidence of SCD is significantly higher in highly-dynamic sports, such as basketball, football, and swimming 1.

Diagnosis and Screening

• Left ventricular hypertrophy (LVH) is a common finding in athletes, but it can be difficult to distinguish from HOCM 1.
• Echocardiography and tissue Doppler imaging (TDI) can be used to diagnose HOCM and distinguish it from physiological LVH in athletes 1.
• Septal E0 <12 cm/s and lateral E0 <12 cm/s on TDI are the best diastolic markers for HOCM in athletes 1.

Management and Recommendations

• Athletes with HOCM should avoid intense competitive sports and participate in low-to-moderate intensity recreational activities instead 1.
• Aerobic exercise, such as swimming or cycling, is preferable to isometric exercise or burst exertion 1.
• Athletes with HOCM should avoid physical activity in extreme environmental conditions and maintain adequate hydration and electrolyte balance 1.

From the Research

Hypertrophic Obstructive Cardiomyopathy (HOCM) in Athletes

• HOCM is a genetic disorder that can increase the risk of sudden cardiac death (SCD) in young athletes 2, 3, 4, 5.
• The prevalence of HOCM in the general population is estimated to be around 0.2% 2.
• Athletes with HOCM are at a higher risk of SCD, with HOCM being the most common cause of SCD in young athletes 2, 3, 5.
• Intensive endurance training can cause physiological cardiac hypertrophy, which can be difficult to distinguish from HOCM 2, 5.
• Differentiation of physiological left ventricular hypertrophy (LVH) from HOCM requires an array of clinical tools, including echocardiography, cardiac-MRI, and genetic testing 2, 5.

Risk of SCD in Athletes with HOCM

• Young age and intense competitive sports are risk factors for SCD in patients with HOCM 4.
• Adolescent and young adult male athletes and athletes participating in high-risk sports such as basketball, soccer, and American football exhibit a greater risk of SCD 4.
• The annual mortality rate for athletes with HOCM is estimated to be higher than that of the general population 4.

Diagnosis and Management of HOCM in Athletes

• Screening for HOCM is undertaken in young athletes, with differing strategies used in Europe and North America 3.
• Early diagnosis and management of HOCM can reduce the risk of SCD, but screening has significant economic costs 3.
• Shared decision-making is endorsed in the sports cardiology community, allowing athletes to make informed decisions about treatment options and potentially continue competitive sports participation 4.