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LIVE-HCM Study: Insights on Hypertrophic Cardiomyopathy Management

May 18, 2023
by Elisabeth Reitman

Vigorous intensity activities are safe for people diagnosed with a common genetic disorder.

The American College of Cardiology (ACC) Annual Scientific Session included a late-breaking clinical trial on the safety of vigorous exercise for individuals with hypertrophic cardiomyopathy (HCM). On Monday, March 6 at 11:00 a.m. CT, Rachel Lampert, MD, Robert W. Berliner Professor of Medicine (Cardiology), presented the results of the Lifestyle and Exercise in HM (LIVE-HCM).

For this study, Lampert and colleagues evaluated the long-term impacts of exercise on arrhythmic events in this population. Previous Yale-led research on competitive athletes with ICDs suggests that the risks could be lower than previously thought.

The genetic mutation for HCM causes the heart muscle to thicken and reduces the heart’s capacity to pump blood. While rare, HCM can cause sudden cardiac death in young adults. Until recently, patients with HCM were advised to avoid vigorous exercise. Funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, the observational trial evaluated the health impacts of activities such as running, swimming, and basketball for individuals with HCM.

If you have HCM, it’s really important to start with an evaluation by a cardiologist who has experience caring for patients with HCM to evaluate your overall risk of arrhythmia and to get up-to-date treatment recommendations.

Rachel Lampert, MD

“In a shared decision-making framework that involves being seen by an experienced HCM physician, our data do not support restriction of vigorous exercise for individuals with HCM,” said Lampert in a related press release. “We know that exercise is beneficial and an important part of life for many people. Evolving how we think about the exercise practices may allow individuals with HCM to garner the longer-term benefits of exercise as well.”

To explore these issues, the research team enrolled 1,534 patients from 36 different U.S and international sites. The patients evaluated their exercise habits and symptoms every six months.

“If you have HCM, it’s really important to start with an evaluation by a cardiologist who has experience caring for patients with HCM to evaluate your overall risk of arrhythmia and to get up-to-date treatment recommendations,” Lampert said. “Experienced HCM physicians are in the best position to advise patients about exercise, provide individualized recommendations and discuss warning signs and plans in case of an emergency.”

Patrice Desvigne-Nickens, MD, a medical officer in the Heart Failure and Arrhythmias Branch in NHLBI’s Division of Cardiovascular Sciences, agreed. “This study makes an important contribution toward understanding the impact of exercise on hypertrophic cardiomyopathy, a complex, poorly understood disease.” Nickens noted that NHLBI funds the Hypertrophic Cardiomyopathy Registry, which seeks to find ways of predicting the risk of developing complications associated with this condition to find better treatments.

The 2023 ACC scientific session were held on Saturday, March 4 - Monday, March 6 at the Ernest N. Morial Convention Center in New Orleans, La.

Findings on HCM and Exercise

The results of LIVE-HCM study were published in the journal JAMA Cardiology on May 17.

“Based on these data, we’re learning that we don’t need to universally restrict HCM patients from participating in vigorous exercise, something that’s so important to all of us,” said Lampert.

“Individuals with this condition should talk to a healthcare provider with expertise in HCM about getting back on the field, back in the pool, and back on the court if that’s what they want to do,” Lampert added. “Getting an expert evaluation is key to determining the degree of risk for all HCM patients, and critical before going back to play.”

The observational study data shows that less than 5% of the participants experienced one of the endpoints (either cardiac arrest, appropriate ICD shock, syncope, or death). Those exercising vigorously did not have a higher rate, with 4.7% of the vigorous group and 4.6% of the non-vigorous experiencing one of these events.

The study was funded by grants from the National Institutes of Health (R01HL125918).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Submitted by Elisabeth Reitman on March 03, 2023