From the Guidelines
Individuals with basal septal left ventricular hypertrophy (LVH) should not participate in ultramarathons due to the increased risk of cardiac events and arrhythmias associated with extreme endurance activities. Basal septal LVH, which involves thickening of the heart muscle at the base of the septum, can increase the risk of cardiac events during prolonged physical activity. According to the American College of Cardiology Foundation/American Heart Association guidelines for the treatment of hypertrophic cardiomyopathy (HCM), patients with HCM should not participate in most competitive sports, with exception of those of low intensity [ 1 ]. Although basal septal LVH is not explicitly mentioned in the guidelines, the principles of minimizing changes in blood pressure and limiting blood flow and cardiac output demand can be applied to individuals with this condition.
The risk of sudden cardiac death due to sympathetic–vagal imbalance, microvascular ischemia, and energetic compromise, including metabolic acidosis, is a concern for individuals with basal septal LVH participating in high-intensity exercise [ 1 ]. Furthermore, high-intensity exercise could lead to increased dynamic left ventricular outflow tract obstruction, increasing left ventricular pressure and wall strain, potentially leading to arrhythmias [ 1 ].
Given the potential risks, it is essential for individuals with basal septal LVH to undergo comprehensive cardiac testing, including echocardiography, stress testing, and possibly cardiac MRI, to assess the severity of their condition and rule out hypertrophic cardiomyopathy [ 1 ]. However, even with thorough evaluation and clearance, the risks associated with ultramarathons may still outweigh the benefits.
Key considerations for individuals with basal septal LVH include:
- Avoiding high-intensity activities, such as ultramarathons, to minimize the risk of cardiac events and arrhythmias
- Engaging in low- to moderate-intensity physical activities, such as walking or yoga, to maintain cardiovascular health and reduce the risk of lifestyle-related cardiometabolic disease [ 1 ]
- Regular cardiac follow-ups every 6-12 months to monitor any progression of the condition
- Staying well-hydrated and monitoring electrolytes during physical activity to reduce the risk of dehydration and electrolyte imbalances [ 1 ]
From the Research
Basal Septal LVH and Ultra Marathons
There is no direct evidence in the provided studies that discusses the relationship between basal septal left ventricular hypertrophy (LVH) and ultra marathons.
Left Ventricular Hypertrophy
- Left ventricular hypertrophy is a nonspecific physiologic or maladaptive cardiac response to a large array of stimuli mediated by exercise and numerous cardiac and systemic diseases 2.
- The clinical reference standard to assess left ventricular hypertrophy is echocardiography 2.
- Isolated basal septal hypertrophy (IBSH) of the left ventricle is not a well understood phenomenon, particularly in the presence of concomitant left ventricular outflow tract obstruction (LVOTO) 3.
Basal Septal Hypertrophy
- Basal septal hypertrophy (BSH) is commonly seen in patients with systemic hypertension and has been associated with increased afterload 4.
- BSH has been associated with decreased regional LV systolic deformation, impaired LV relaxation, and LA functional impairment 4.
- The morphology of the basal septum contributes to left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy 5.
Left Ventricular Outflow Tract Obstruction
- Significant LVOT obstruction may develop in patients with basal septal hypertrophy and is potentially responsive to pharmacotherapy 6.
- Orthostatic assessment of LVOT gradient using echocardiography should be considered during standard LVOT obstruction provocation maneuvers such as a Valsalva 6.
- LVOTO occurs only when concomitant mitral valve co-aptation and LV hypercontractility facilitate development of a gradient, rather than through differences in the degree of basal septal myocardial hypertrophy 3.