Vigorous Exercise in Patients With Hypertrophic Cardiomyopathy

Author:

Lampert Rachel1,Ackerman Michael J.234,Marino Bradley S.56,Burg Matthew1,Ainsworth Barbara7,Salberg Lisa8,Tome Esteban Maria Teresa9,Ho Carolyn Y.10,Abraham Roselle11,Balaji Seshadri12,Barth Cheryl1,Berul Charles I.1314,Bos Martijn234,Cannom David15,Choudhury Lubna16,Concannon Maryann17,Cooper Robert18,Czosek Richard J.19,Dubin Anne M.20,Dziura James21,Eidem Benjamin2223,Emery Michael S.2425,Estes N. A. Mark2627,Etheridge Susan P.28,Geske Jeffrey B.2,Gray Belinda29,Hall Kevin30,Harmon Kimberly G.31,James Cynthia A.11,Lal Ashwin K.28,Law Ian H.32,Li Fangyong21,Link Mark S.2633,McKenna William J.34,Molossi Silvana35,Olshansky Brian36,Ommen Steven R.2,Saarel Elizabeth V.537,Saberi Sara17,Simone Laura21,Tomaselli Gordon1138,Ware James S.39,Zipes Douglas P.25,Day Sharlene M.1740,Abrahms Dominic41,Ashley Euan41,Aziz Peter41,Batra Anjan41,Cerrone Marina41,Colan Steven41,Erickson Christopher41,Ferhaan Ahmad41,Gollob Michael J.41,Johnsrude Christopher41,Kannankeril Prince41,Kanter Ronald41,Li Walter41,Masri Ahmad41,Murphy Ann41,Nandi Deipanjan41,Perez Marco41,Perry James41,Popjes Eric41,Rao Roopa41,Rosenthal David41,Sanatani Shubhayan41,Semsarian Chris41,Shah Maully41,Skinner Jonathan41,Tardif Jill41,Towbin Jeffrey41,Turer Aslan41,Webster Gregory41,Wever-Pinzon Omar41,Wong Timothy41,

Affiliation:

1. Department of Medicine, Yale School of Medicine, New Haven, Connecticut

2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota

3. Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota

4. Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota

5. Department of Pediatric Cardiology, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio

6. Lurie Children’s Hospital, Chicago, Illinois

7. College of Health Solutions, Arizona State University, Tempe

8. Hypertrophic Cardiomyopathy Association, Denville, New Jersey

9. St George’s Hospital NHS Foundation Trust/St George’s University of London, London, United Kingdom

10. Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts

11. Department of Medicine, Johns Hopkins University, Baltimore, Maryland

12. Department of Pediatrics, Oregon Health and Science University, Portland

13. Division of Cardiology, Children’s National Hospital, Washington, DC

14. Department of Pediatrics, George Washington University School of Medicine, Washington, DC

15. Division of Cardiology, PIH Health Good Samaritan Hospital, Los Angeles, California

16. Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois

17. Department of Internal Medicine, University of Michigan, Ann Arbor

18. Department of Cardiology, Liverpool Heart and Chest Hospital/Liverpool John Moores University, Liverpool, United Kingdom

19. Department of Pediatrics, Heart Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio

20. Department of Pediatrics, Stanford School of Medicine, Stanford, California

21. Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut

22. Department of Cardiology, Mayo Clinic, Rochester, Minnesota

23. Department of Pediatrics, Mayo Clinic, Rochester, Minnesota

24. Department of Cardiovascular Medicine, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio

25. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

26. Department of Medicine, Tufts Medical Center, Boston, Massachusetts

27. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

28. Department of Pediatrics, Primary Children’s Hospital, Salt Lake City, Utah

29. Faculty of Medicine and Health, Royal Prince Alfred Hospital/Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

30. Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut

31. Department of Family Medicine, University of Washington, Seattle

32. Department of Pediatrics, University of Iowa, Iowa City

33. Department of Internal Medicine, University of Texas, Southwestern, Dallas

34. Institute of Cardiovascular Medicine, University College London, London, United Kingdom

35. Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston

36. Department of Internal Medicine, University of Iowa, Iowa City

37. Department of Pediatric Cardiology, St Luke’s Health System, Boise, Idaho

38. Department of Medicine, Albert Einstein College of Medicine, Bronx, New York

39. National Heart and Lung Institute & MRC London Institute of Medical Sciences, Imperial College London/ Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust

40. Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia

41. for the LIVE Consortium

Abstract

ImportanceWhether vigorous intensity exercise is associated with an increase in risk of ventricular arrhythmias in individuals with hypertrophic cardiomyopathy (HCM) is unknown.ObjectiveTo determine whether engagement in vigorous exercise is associated with increased risk for ventricular arrhythmias and/or mortality in individuals with HCM. The a priori hypothesis was that participants engaging in vigorous activity were not more likely to have an arrhythmic event or die than those who reported nonvigorous activity.Design, Setting, and ParticipantsThis was an investigator-initiated, prospective cohort study. Participants were enrolled from May 18, 2015, to April 25, 2019, with completion in February 28, 2022. Participants were categorized according to self-reported levels of physical activity: sedentary, moderate, or vigorous-intensity exercise. This was a multicenter, observational registry with recruitment at 42 high-volume HCM centers in the US and internationally; patients could also self-enroll through the central site. Individuals aged 8 to 60 years diagnosed with HCM or genotype positive without left ventricular hypertrophy (phenotype negative) without conditions precluding exercise were enrolled.ExposuresAmount and intensity of physical activity.Main Outcomes and MeasuresThe primary prespecified composite end point included death, resuscitated sudden cardiac arrest, arrhythmic syncope, and appropriate shock from an implantable cardioverter defibrillator. All outcome events were adjudicated by an events committee blinded to the patient’s exercise category.ResultsAmong the 1660 total participants (mean [SD] age, 39 [15] years; 996 male [60%]), 252 (15%) were classified as sedentary, and 709 (43%) participated in moderate exercise. Among the 699 individuals (42%) who participated in vigorous-intensity exercise, 259 (37%) participated competitively. A total of 77 individuals (4.6%) reached the composite end point. These individuals included 44 (4.6%) of those classified as nonvigorous and 33 (4.7%) of those classified as vigorous, with corresponding rates of 15.3 and 15.9 per 1000 person-years, respectively. In multivariate Cox regression analysis of the primary composite end point, individuals engaging in vigorous exercise did not experience a higher rate of events compared with the nonvigorous group with an adjusted hazard ratio of 1.01. The upper 95% 1-sided confidence level was 1.48, which was below the prespecified boundary of 1.5 for noninferiority.Conclusions and RelevanceResults of this cohort study suggest that among individuals with HCM or those who are genotype positive/phenotype negative and are treated in experienced centers, those exercising vigorously did not experience a higher rate of death or life-threatening arrhythmias than those exercising moderately or those who were sedentary. These data may inform discussion between the patient and their expert clinician around exercise participation.

Publisher

American Medical Association (AMA)

Subject

Cardiology and Cardiovascular Medicine

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