Shifting Paradigms in Hypertrophic Cardiomyopathy: The Role of Exercise in Disease Management.

Hypertrophic cardiomyopathy (HCM) is traditionally associated with exercise restriction due to potential risks, yet recent evidence and guidelines suggest a more permissive stance for low-risk individuals. The aim of this comprehensive review was to examine existing research on the impact of exercise on cardiovascular outcomes, safety, and quality of life in this population and to consider implications for clinical practice. Recent studies suggest that regular exercise and physical activity in low-risk individuals with HCM are associated with positive outcomes in functional capacity, haemodynamic response, and quality of life, with consistent safety. Various studies highlight the safety of moderate-intensity exercise, showing improvements in exercise capacity without adverse cardiac remodelling or significant arrhythmias. Psychological benefits, including reductions in anxiety and depression, were also reported following structured exercise programs. These findings support the integration of individualised exercise regimens in the management of low-risk individuals with HCM, potentially improving overall well-being and cardiovascular health. Adoption of the FITT principle, consideration of individual risk profiles, and shared decision-making are recommended. Future research is warranted to clarify the definition of 'low-risk' for exercise participation and investigate the influence of physical activity on disease progression in HCM. Innovation in therapeutic strategies and lifestyle interventions, alongside improved patient and provider education, will help advance the care and safety of individuals with HCM engaging in exercise.

Native T1 and T2 reference values for maltese healthy cohort.

Cardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various cardiac conditions. Parametric mapping enables quantitative myocardial characterization by directly measuring myocardial T1 and T2 values. However, reference values of parametric mapping are not standardized across different vendors and scanners, causing drawbacks for clinical implementation of this technique across different sites. We assessed the reference ranges of native T1 and T2 values in a healthy Maltese cohort to establish a local parametric mapping service. Healthy subjects [n = 51; mean age 36.0 (range 19-59) years] with normal cardiac function on CMR were recruited. Subjects underwent uniform parametric mapping pulse sequences [MOLLI 5b(3b)3b for native T1 mapping, and gradient echo single shot FLASH readout for T2 mapping] on a 3 T Siemens MAGNETOM Vida scanner. Native T1 and T2 values were measured by placing a region of interest within the interventricular septum at midventricular level. Intra- and inter-observer variability were assessed using Bland-Altman plots. Mean ± 1.96 SD was used as a reference range. Mean native T1 and T2 values were 1200.1 ± 30.7 ms and 39.5 ± 1.8 ms, respectively. There was no significant bias in repeated measurements by the same and different observers. For the first time in Malta, we established the native T1 and T2 parametric mapping reference values for healthy Caucasian Maltese individuals. This will assist cardiologists to establish diagnosis, disease progression, and response to treatment of various myocardial diseases locally.

A review article of the cardiovascular sequalae in esport athletes: A cause for concern?

The esports industry has grown exponentially and is expected to flourish rapidly in the coming years. Awareness about the cardiovascular sequalae in elite esports athletes has gained considerable momentum. Evidence supporting systematic screening in esports athletes is however lacking. In this narrative review, we discuss potential negative health effects on the cardiovascular system in esports enthusiasts. The pathophysiological mechanisms discussed in this narrative review may put esports athletes at an increased risk of cardiovascular events. Although large studies in esports athletes to substantiate these claims are inexistent, case reports or case-controlled studies have been included to support our hypotheses. Sleep deprivation, psychological stress, altered arterial stiffness, hypertension, and heart rate variability are some of these proposed mechanisms. The available data are unfortunately extrapolated from small cohorts. Nevertheless, the risk of sudden cardiac death is an important health concern, which should be addressed appropriately. This review will raise awareness about the possible negative impact on the cardiovascular system in esports athletes.