Competitive athletes with hypertrophic or dilated cardiomyopathy: sports eligibility according to the current Italian guidelines

The Italian Cardiological Guidelines (COCIS) for competitive sports eligibility aims to assist physicians in evaluating athletes with cardiovascular conditions. The primary objective is to balance the significant benefits of physical activity with the risks of sudden cardiac death (SCD) in competitive sports. Historically, the COCIS guidelines have adopted a cautious approach, influenced by Italy’s regulatory framework, which mandates a medical certificate for participation in competitive sports. The 2023 COCIS guidelines introduce significant advancements that enhance the evaluation process. These revised guidelines place a strong emphasis on personalized risk stratification. This approach enables physicians in specialized centers to make eligibility decisions based on an athlete’s individual risk profile. Consequently, athletes with a low-risk profile may now be eligible for all types of sports, marking a substantial shift from the 2017 guidelines, which restricted even low-risk patients to low-intensity sports. On the other hand, the 2023 COCIS guidelines further reinforced some traditional concepts of the athlete’s cardiovascular evaluation that have been the basis for an appropriate interpretation of clinical findings and the reduction of SCD in competitive athletes. This review critically examines the 2023 COCIS guidelines, focusing on their advancements compared to the 2017 edition and exploring their alignment with international standards, including the European Society of Cardiology and the American College of Cardiology recommendations.