[Korzun]

Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis.

Hypertrophic Cardiomyopathy
Recommendations
1. Participation in competitive athletics for asymptomatic, genotype-positive HCM patients without evidence of LV hypertrophy by 2-dimensional echocardiography and CMR is reasonable, particularly in the absence of a family history of HCM-related sudden death (Class IIa; Level of Evidence C).

2. Athletes with a probable or unequivocal clinical expression and diagnosis of HCM (ie, with the disease phenotype of LV hypertrophy) should not participate in most competitive sports, with the exception of those of low intensity (class IA sports) (see “Classification of Sport” [22]). This recommendation is independent of age, sex, magnitude of LV hypertrophy, particular sarcomere mutation, presence or absence of LV outflow obstruction (at rest or with physiological exercise), absence of prior cardiac symptoms, presence or absence of late gadolinium enhancement (fibrosis) on CMR, and whether major interventions such as surgical myectomy or alcohol ablation have been performed previously (Class III; Level of Evidence C).

3. Pharmacological agents (e.g., β-blockers) to control cardiac-related symptoms or ventricular tachyarrhythmias should not be administered for the sole purpose of permitting participation in high-intensity sports. Notably, such drugs may also be inconsistent with maximal physical performance in most sports (Class III; Level of Evidence C).

4. Prophylactic ICDs should not be placed in athlete-patients with HCM for the sole or primary purpose of permitting participation in high-intensity sports competition because of the possibility of device-related complications. ICD indications for competitive athletes with HCM should not differ from those in nonathlete patients with HCM (Class III; Level of Evidence B).

LV Noncompaction
Recommendations
1. Until more clinical information is available, participation in competitive sports may be considered for asymptomatic patients with a diagnosis of LVNC and normal systolic function, without important ventricular tachyarrhythmias on ambulatory monitoring or exercise testing, and specifically with no prior history of unexplained syncope (Class IIb; Level of Evidence C).

2. Athletes with an unequivocal diagnosis of LVNC and impaired systolic function or important atrial or ventricular tachyarrhythmias on ambulatory monitoring or exercise testing (or with a history of syncope) should not participate in competitive sports, with the possible exception of low-intensity class 1A sports, at least until more clinical information is available (Class III; Level of Evidence C).

Other Myocardial Diseases
Recommendations
1. Symptomatic athletes with DCM, primary nonhypertrophied restrictive cardiomyopathy, and infiltrative cardiac myopathies should not participate in most competitive sports, with the possible exception of low-intensity (class 1A sports) in selected cases, at least until more information is available (Class III; Level of Evidence C).

Myocarditis
Recommendations
1. Before returning to competitive sports, athletes who initially present with an acute clinical syndrome consistent with myocarditis should undergo a resting echocardiogram, 24-hour Holter monitoring, and an exercise ECG no less than 3 to 6 months after the initial illness (Class I; Level of Evidence C).

2. It is reasonable that athletes resume training and competition if all of the following criteria are met (Class IIa; Level of Evidence C):

a. Ventricular systolic function has returned to the normal range.

b. Serum markers of myocardial injury, inflammation, and heart failure have normalized.

c. Clinically relevant arrhythmias such as frequent or complex repetitive forms of ventricular or supraventricular ectopic activity are absent on Holter monitor and graded exercise ECGs.

At present, it is unresolved whether resolution of myocarditis-related LGE should be required to permit return to competitive sports.

3. Athletes with probable or definite myocarditis should not participate in competitive sports while active inflammation is present. This recommendation is independent of age, gender, and LV function (Class III; Level of Evidence C).

Arrhythmogenic Right Ventricular Cardiomyopathy
Recommendations
1. Athletes with a definite diagnosis of ARVC should not participate in most competitive sports, with the possible exception of low-intensity class 1A sports (Class III; Level of Evidence C).

2. Athletes with a borderline diagnosis of ARVC should not participate in most competitive sports, with the possible exception of low-intensity class 1A sports (Class III; Level of Evidence C).

3. Athletes with a possible diagnosis of ARVC should not participate in most competitive sports, with the possible exception of low-intensity class 1A sports (Class III; Level of Evidence C).

4. Prophylactic ICD placement in athlete-patients with ARVC for the sole or primary purpose of permitting participation in high-intensity sports competition is not recommended because of the possibility of device-related complications (Class III; Level of Evidence C).

Pericarditis
Recommendations
1. Athletes with pericarditis, regardless of its pathogenesis, should not participate in competitive sports during the acute phase. Such athletes can return to full activity when there is complete absence of evidence for active disease, including effusion by echocardiography, and when serum markers of inflammation have normalized. For pericarditis associated with evidence of myocardial involvement, eligibility should also be based on the course of myocarditis. Chronic pericardial disease that results in constriction disqualifies the person from all competitive sports (Class III; Level of Evidence C).

Резюме.
Гипертрофическая кардиомиопатия.
Генетические положительные, но без клинических проявлений, нормальной ЭхоКг и без плохого анамнеза могут быть допущены.
Люди с вероятным или установленным клиническим диагнозом не должны участвовать в большинстве соревновательных видов спорта, за исключением видов спорта с низкой интенсивностью (спорт класса IA), независимо от пола, возраста, выраженности гипертрофии.
Лекарства, например, бетаблокаторы, не должны использоваться с целью разрешить участие.
ИКД не имплантируют только ради участия в соревнованиях. Показания к ИКД такие же как у всех остальных.

Некомпактный миокард
Если без симптомов и анамнеза, то ситуация малоизучена и можно допустить.
Если есть симптомы и анамнез, то не допускать, за возможным исключением класса низкой интенсивности 1A.

Другие заболевания миокарда - не должны участвовать в спорте, за возможным исключением класса низкой интенсивности 1A.

Миокардит
Перед тем как вернуться к соревнованиям нужны ЭхоКг, ЭКГ с нагрузкой и Холтер в течение 3-6 месяцев как до заболевания.
Спортсмены с вероятным или установленным не участвуют, независимо от возраста, пола и функции ЛЖ.

Аритмогенная дисплазия правого желудочка
Вероятный, возможный и пограничный диагноз = противопоказание к спорту, за возможным исключением класса низкой интенсивности 1A (гольф, боулинг). ИКД не имплантируют ради цели участия в соревнованиях.

Перикардит
Во время острой фазы нельзя, если хронизируется - нельзя.
Возврат возможен при полном выздоровлении.