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Background Appropriate advice for the practice of sport in patients with a cardiomyopathy is a challenging issue. Recent evolution towards more comprehensive and tailored recommendations may facilitate the clinical practice. However, neither their application in real life has been evaluated nor the concordance within clinicians. Methods We submitted six cases from real life to an expert panel of eighteen clinicians (7 cardiomyopathy experts, 7 arrhythmia experts, 4 sport physicians). The six athletes had Hypertrophic (HCM, n = 3), Dilated (DCM, n = 2), Right ventricular arythmogenic (ARVC, n = 1) cardiomyopathy. Advice for the practice of sport (competitive or recreational, globally or regarding the main usual activity of the athlete or according to detailed sports classification) was collected through a structured questionnaire. Results Experts authorize the practice of the usual sport in 28% of total cases. Global concordance within experts is significant but low (Kendall W = 0.34, P Conclusions Divergent advices were observed between experts regarding sports activity that can be authorized in athletes with a cardiomyopathy. Advices were also frequently discordant with recent European recommendations. These results underline difficulties for athletes’ personalized recommendation and the need for large prospective studies to progress towards optimal management.

International audience; Background Rest echocardiography plays a role in the diagnosis and risk stratification of hypertrophic cardiomyopathy (HCM). Indeed, left atrial enlargement, severe left ventricle (LV) hypertrophy and rest LV outflow tract (LVOT) gradients ≥50mmHg are sudden cardiac death risk factors as highlighted in recent guidelines. Conversely, exercise echocardiography findings play only a limited role in prognosis evaluations. Therefore, we sought to determine whether exercise induced changes in myocardial and valvular functions could improve HCM risk stratification. Methods and results Consecutive HCM patients with a preserved LV ejection fraction underwent standardized exercise echocardiography (including the assessment of myocardial function, dynamic left intra-ventricular gradient and valvular regurgitations) at baseline and were clinically followed for a median of 29.3 months. The primary endpoint was a composite criterion that included death from any cause, cardiorespiratory arrest, and hospitalization for a cardiovascular event. A total of 126 patients were included. Eighteen patients reached the primary endpoint. According to univariate Cox regression analysis, exercise LVOT gradient ≥50mmHg (HR=3.31, p=0.01) and significant (≥2/4) exercise mitral regurgitation (HR=3.64, p

Purpose Endurance trained athletes show more positive tilt tests and more arrhythmias than non-trained people. The mechanisms remain unclear, several hypotheses exist including structural and autonomic cardiac adaptations. Training bradycardia (heart rate (HR) Method Untrained non bradycardic subjects (UTNB, n=16, HR=66,1±5,9 bpm) were compared with trained non bradycardic athletes (TNB, n=13, HR=61,3±3,3 bpm) to specify the influence of endurance training. Also TNB were compared to trained bradycardic athletes (TB, n=17, HR=43,8±3,1 bpm) to specify the influence of bradycardia. All subjects were healthy men between 18 and 36 years old. They performed incremental maximal exercise test, resting echocardiography, 24h ECG Holter monitoring, and 45 min of an 80° tilt test. Results Training history did not differ between TNB and TB (8,3±2,8 vs 8,8±3,1 hours/week since 8,1±4,2 vs 6,4±4,6 years). VO2max was 43,5± 5,9 ml/min/kg in UTNB, 67,9±6,2 in TNB (p Conclusion From our results, training bradycardia does not seem to be an additional risk factor for syncope or arrhythmias in endurance athletes. However VASIS II reactions are more frequent in bradycardic athletes who experienced syncope. Download : Download full-size image Table – Tilt test results in NTNB, TNB and TB sujects

Background Despite extensive research on this subject, differentiation of pathologic from physiologic left ventricular (LV) hypertrophy remains challenging. Purpose We sought to describe LV-myocardial deformations at rest and during exercise in the perspective of differentiating forms of LV remodeling. Methods This prospective study included 17 healthy sedentary control subjects and 36 subjects with LV hypertrophy (H): 10 elite athletes (kayakers), 10 patients with primitive hypertrophic cardiomyopathy, six patients with LVH exclusively due to hypertension, and 10 patients with both LVH and asymptomatic severe aortic stenosis. Each patient was investigated according to the same standardized protocol of exercise echocardiography. Results The groups showed similar LV ejection fractions. The resting diastolic and systolic deformation parameters were significantly different in physiologic and pathologic hypertrophy patients, but overlapped between groups. Exercise widened these differences: E/E’, S’, mean longitudinal and radial strains, and mean circumferential strain were significantly different between LVH types. According to ROC-analysis, the (especially septal) exercise longitudinal strain provided a discriminative cut-off depending on the LVH etiology (AUC 0.9; cut-off -18.4 = sensibility 0.80; specificity 0.88). Conclusion The additive value of echocardiographic deformations during exercise in differentiating physiologic and pathologic LV-hypertrophy is providing clues for difficult diagnosis in routine clinic.

BackgroundT-wave inversion beyond V1 is rarely observed on the ECG of healthy athletes (< 4%), whereas it is a common finding in patients with cardiomyopathy. Thus recent ESC recommendations for interpretation of resting ECG in the athlete underlined that this ECG pattern is not due to physical training and request cardiovascular exams. Classical exam performed is resting echocardiography. In this prospective study the respective value of different non invasive exams performed in case of negative T waves in athletes was evaluated.MethodWe prospectively included 49 athletes with T-wave inversion beyond V1. They underwent intensive cardiac investigations (exercise test, 24h ECG Holter monitor, rest and exercise echocardiography, cardiac MRI) to identify a potential cause.ResultsIn all cases ECG was realized for pre-participation screening. Only few subjects reported cardiovascular symptoms (n=10) or cardiac murmur (n=5). Thus in most cases no evidence of cardiovascular disease (n=34) was noted. In 25 subjects no significant abnormality was detected. Cardiomyopathy was diagnosed in 24 (49%) subjects, 20 HCM, 1 ARVC and 3 resolutives myocarditis. In the cardiac disease group, only 4 presented cardiovascular symptoms vs 6 in the non pathologic one (n=25). In 2 patients with myocarditis but normal echocardiography, the diagnosis was performed by cardiac MRI because of evidence of late gadolinium enhancement (LGE). LGE was also useful for risk stratification in HCM patients (8). Exercise echocardiography was very useful in 2 patients for the diagnosis of HCM by unmasking dynamic LVOT obstruction, and in 1 patient with myocarditis by showing absence of contractile reserve.ConclusionT-wave inversions in athletes cannot be regarded as a physiological adaptation even in absence of symptoms. An intensive cardiac evaluation is necessary including cardiac MRI and exercise echocardiography in subjects with considered normal resting echocardiography and exercise ECG.