[Cardiomyopathy and sport].

Hypertrophic cardiomyopathy (HCM) remains the main cause of sudden death in top class sportsmen and women. In these persons, practicing over 10 hours of sport per week and/or engaging in competitions in the younger age group, the distinction between physiological and pathological left ventricular hypertrophy, (LVH) is usually easy. In favour of physiological LVH, the hypertrophy is symmetrical, < 13mm on echocardiography (12mm in women and adolescents), non obstructive, with normal or slightly increased left ventricular size (> or = 55mm), only slight left atrial dilatation, mitral E/A ratio > 1 with normal tissue Doppler parameters, normal ECG with no symptoms or family history (HCM or sudden death). When left ventricular wall thickness is 13 to 15 mm, in the absence of these reassuring criteria, further investigations (stress ECG and echocardiography, Holter ECG) should be systematic, as should be a family enquiry and, if possible, echocardiography after stopping training in order to check regression of the LVH. Left ventricular wall thickness > 15mm should be considered HCM and sporting activities should be forbidden. The problem of dilated cardiomyopathy should be considered when LV diastolic diameters > 60mm (especially as its regression after stopping training is variable) and LV ejection fractions are < 50% and do not improve on exercise: other warning signs include regional dilatation and wall motion abnormalities, abnormal Doppler filling indices or a positive family history.