Elite athletes with genetic heart disease can safely return to play with diagnosis and treatment, early study suggests

In a new study, most elite athletes diagnosed with a genetic heart disease didn’t show any serious or fatal symptoms of their condition, such as: B. sudden cardiac death. Research suggests that it may be “feasible” and “safe” for athletes to continue participating in their sport.

In a sample of 76 elite athletes with a genetic heart disease who competed or competed in either collegiate or professional sports Division I, 73 of 76 did not experience a cardiac event related to their disease during the study period, the study said Researchers behind a landmark clinical study presented Monday at the American College of Cardiology’s annual scientific meeting in conjunction with the World Congress of Cardiology.

Among those top athletes with a genetic heart disease, 40 of them — 52 percent — were asymptomatic, according to the study’s abstract.

Over the years, researchers have become aware of alarming reports of top athletes suffering from heart problems or even suddenly collapsing while playing.

“For athletes with genetic heart disease, and I would add non-athletes, the tragedies happen when we don’t know about their condition,” said Dr. Michael Ackerman, a genetic cardiologist at the Mayo Clinic in Rochester, Minnesota, who is a senior author of the new research. “If we know their condition, carefully assess the risk and treat well, these athletes and non-athletes can expect to live and thrive despite their condition.”

The new research has not yet been published in a peer-reviewed journal, but the results suggest that many athletes with a genetic heart disease can work with their healthcare professionals to decide whether to continue competing and how to do so safely instead do may be automatically disqualified based on their medical condition.

“In sport historically we have been paternalistic and emphasize patient preferences and risk tolerance, but we know that athletes come from all walks of life. They are intelligent, and when there is scientific uncertainty, their values ​​should be factored into the medical decision-making,” said Dr. J. Sawalla Guseh, a cardiologist at Massachusetts General Hospital who was not involved in the new study, during the scientific session on Monday.

“Shared decision-making, when done well, can have very positive outcomes,” he said.

ATHLETES AND HEART RISKS

Elite basketball, hockey, soccer and football players were among the 76 athletes enrolled in the new study, conducted by researchers from the Mayo Clinic and other institutions across the United States. They wrote in their study abstract that, to their knowledge, this is the first study to describe the experience of athletes competing at the NCAA Division I level or in professional sports with a known genetic heart disease that puts them at risk of sudden cardiac death.

Athletes in the study were cleared to return to play at either an NCAA Division I school or at the professional level. They were followed for an average of seven years, and all had been diagnosed with a genetic heart disease within the past 20 years and treated at either the Mayo Clinic, Morristown Medical Center, Massachusetts General Hospital, or the Atrium Health Sports Cardiology Center.

“Only three of them had a breakthrough cardiac event, meaning they still had an event after diagnosis and treatment,” said Katherine Martinez, a graduate student at Loyola University in Baltimore who was an intern helping conduct the research on Windland Smith Rice Sudden Death Genomics Laboratory at Mayo Clinic.

Fainting was the most common event, and one athlete received a shock with an implantable cardioverter-defibrillator, or ICD. None of the athletes died.

“The majority of these athletes continued their careers without events,” Martinez said. But most of the athletes in the study — 55 of them, or 72% — were initially banned from competing by their main provider or institution after their diagnosis. Most eventually decided to play again without restrictions after undergoing extensive clinical evaluations and speaking to their doctors.

While each sports league has its own set of rules, in the past some people diagnosed with a genetic heart disease that puts them at increased risk of sudden cardiac death have been banned from competitive sports, the researchers write in their abstract of the study.

“Just because you’ve received this diagnosis doesn’t mean your life, your career, the future you see for yourself is over, but that you’re getting a second opinion from an expert who knows what they’re doing and that you’re comfortable with making a decision is the next step,” said Martinez, who worked on the new study with her father, Dr. Matthew Martinez, director of the Atlantic Health System Sports Cardiology at Morristown Medical Center and author of the new study .

Referring to the new study, “The take-home message is, if you have any of these findings, see an expert who can help you find a safe exercise plan for you and determine at what level.” You can continue to participate safely.” he said. “This is the next best step – the next evolution – in managing athletes with genetic heart disease.”

“Do we need to take a closer look?”

Leaving your sport because of genetic heart disease can be “very destructive” for athletes who have dedicated their lives to excelling at competitions, said Dr. Lior Jankelson, director of the inherited arrhythmia program at NYU Langone Heart in New York, who was not involved in the new research.

However, he added that these athletes still need to consult with their doctors and be closely monitored, as some genetic diseases could be more likely to cause a serious cardiac event than others.

The new study highlights that “after careful, meticulous expert risk stratification and treatment strategy, the majority of athletes with genetic heart disease are likely to be able to participate in sport,” Jankelson said. “But at the same time, that is exactly why these patients should only be treated in highly specialized genetic cardiology clinics, because there are other genetic diseases that can respond very unfavorably to exercise and have a much higher risk profile of developing an arrhythmia.” during intense activity.”

Separately, the NCAA Sports Science Institute notes on its website, “Although many student-athletes with heart disease can lead active lives and have no health problems, sudden death from heart disease remains the leading medical cause of death in collegiate athletes.” “

For athletes with a genetic heart disease, their symptoms and family history of cardiac events should be considered when determining risk, said Dr. Jayne Morgan, a cardiologist at Piedmont Healthcare in Atlanta, who was not involved in the new study.

“Certainly there are concerns about the participation of elite athletes and whether or not they will be adequately screened,” Morgan said. However, she added that the new research offers “some understanding” of the mental health implications of athletes with a genetic heart disease who may need to refrain from a competitive sport they love.

“I think this study goes a long way in helping potentially reduce the need for us to pull the trigger so quickly and for athletes to step away from something they love,” Morgan said.

The new study is “timely” given the recent national attention to athletes and their risk of sudden cardiac death, said Dr. Deepak Bhatt, director of Mount Sinai Heart in New York City, who was not involved in the research, in an email.

“This is some of the best data showing that the risk of a return to play may not be as great as we fear,” Bhatt said of the new study.

“Some caveats include that the majority of these athletes had no symptoms and about a third had an implantable defibrillator,” he added. “Any decision to return to sport should be made after a careful discussion of the potential risks, including those that are difficult to quantify. The input of experts in genetic cardiology and sports cardiology can be very helpful in these cases.”