Basavarajaiah S et al. (2008) Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening. J Am Coll Cardiol 51: 1033–1039

Hypertrophic cardiomyopathy (HCM) is considered to be the most common cause of exercise-related sudden death in young athletes. A number of sporting institutions in the UK have implemented programs to screen athletes for HCM; however, a study by Basavarajaiah et al. has shown that there is little justification for these programs because the prevalence of HCM among elite athletes is extremely low.

During the period 1996–2006, 3,500 asymptomatic British athletes (mean age 20.5 years) with no known family history of HCM underwent 12-lead electrocardiography and two-dimensional transthoracic echocardiography. A diagnosis of HCM was excluded in 3,447 (98.5%) of the athletes screened, on the basis of a left ventricular (LV) wall thickness of <12 mm, the absence of LV outflow obstruction, and normal diastolic function. An LV wall thickness of >12 mm was noted in 53 patients, 50 of whom had a dilated left ventricle and normal systolic function, indicating physiological LV hypertrophy. The remaining three athletes had nondilated left ventricles and deep T-wave inversions, possibly indicating mild HCM; however, none of these individuals had any other echocardiographic features of this condition, and further noninvasive investigations failed to uncover any additional features suggestive of HCM. In the one athlete persuaded to abstain from training for 12 weeks, the LV hypertrophy and deep T-wave inversion resolved, excluding a diagnosis of HCM.

HCM is extremely rare among elite athletes, conclude the authors, and echocardiographic screening should be conducted in only those athletes with characteristics suggestive of an underlying cardiac condition.