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Fumagalli C, Maurizi N, Day SM, Ashley EA, Michels M, Colan SD, Jacoby D, Marchionni N, Vincent-Tompkins J, Ho CY, Olivotto I. Association of Obesity With Adverse Long-term Outcomes in Hypertrophic Cardiomyopathy. JAMA Cardiol 2021; 5:65-72. [PMID: 31693057 DOI: 10.1001/jamacardio.2019.4268] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Patients with hypertrophic cardiomyopathy (HCM) are prone to body weight increase and obesity. Whether this predisposes these individuals to long-term adverse outcomes is still unresolved. Objective To describe the association of body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) with long-term outcomes in patients with HCM in terms of overall disease progression, heart failure symptoms, and arrhythmias. Design, Setting, and Participants In this cohort study, retrospective data were analyzed from the ongoing prospective Sarcomeric Human Cardiomyopathy Registry, an international database created by 8 high-volume HCM centers that includes more than 6000 patients who have been observed longitudinally for decades. Records from database inception up to the first quarter of 2018 were analyzed. Patients were divided into 3 groups according to BMI class (normal weight group, <25; preobesity group, 25-30; and obesity group, >30). Patients with 1 or more follow-up visits were included in the analysis. Data were analyzed from April to October 2018. Exposures Association of baseline BMI with outcome was assessed. Main Outcome and Measures Outcome was measured against overall and cardiovascular mortality, a heart failure outcome (ejection fraction less than 35%, New York Heart Association class III/IV symptoms, cardiac transplant, or assist device implantation), a ventricular arrhythmic outcome (sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter-defibrillator therapy), and an overall composite outcome (first occurrence of any component of the ventricular arrhythmic or heart failure composite end point, all-cause mortality, atrial fibrillation, or stroke). Results Of the 3282 included patients, 2019 (61.5%) were male, and the mean (SD) age at diagnosis was 47 (15) years. These patients were observed for a median (interquartile range) of 6.8 (3.3-13.3) years. There were 962 patients in the normal weight group (29.3%), 1280 patients in the preobesity group (39.0%), and 1040 patients in the obesity group (31.7%). Patients with obesity were more symptomatic (New York Heart Association class of III/IV: normal weight, 87 [9.0%]; preobesity, 138 [10.8%]; obesity, 215 [20.7%]; P < .001) and more often had obstructive physiology (normal weight, 201 [20.9%]; preobesity, 327 [25.5%]; obesity, 337 [32.4%]; P < .001). At follow-up, obesity was independently associated with the HCM-related overall composite outcome (preobesity vs normal weight: hazard ratio [HR], 1.102; 95% CI, 0.920-1.322; P = .29; obesity vs normal weight: HR, 1.634; 95% CI, 1.332-1.919; P < .001) and the heart failure composite outcome (preobesity vs normal weight: HR, 1.192; 95% CI, 0.930-1.1530; P = .20; obesity vs normal weight: HR, 1.885; 95% CI, 1.485-2.393; P < .001) irrespective of age, sex, left atrium diameter, obstruction, and genetic status. Obesity increased the likelihood of atrial fibrillation but not of life-threatening ventricular arrhythmias. Conclusions and Relevance Obesity is highly prevalent among patients with HCM and is associated with increased likelihood of obstructive physiology and adverse outcomes. Strategies aimed at preventing obesity and weight increase may play an important role in management and prevention of disease-related complications.
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Affiliation(s)
- Carlo Fumagalli
- Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Niccolò Maurizi
- Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | | | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, Stanford, California
| | | | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Niccolò Marchionni
- Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | | | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
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152
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Niaz T, Hope K, Fremed M, Misra N, Altman C, Glickstein J, Sanchez-de-Toledo J, Fraisse A, Miller J, Snyder C, Johnson JN, Chowdhury D. Role of a Pediatric Cardiologist in the COVID-19 Pandemic. Pediatr Cardiol 2021; 42:19-35. [PMID: 33015722 PMCID: PMC7533115 DOI: 10.1007/s00246-020-02476-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has affected patients across all age groups, with a wide range of illness severity from asymptomatic carriers to severe multi-organ dysfunction and death. Although early reports have shown that younger age groups experience less severe disease than older adults, our understanding of this phenomenon is in continuous evolution. Recently, a severe multisystem inflammatory syndrome in children (MIS-C), with active or recent COVID-19 infection, has been increasingly reported. Children with MIS-C may demonstrate signs and symptoms of Kawasaki disease, but also have some distinct differences. These children have more frequent and severe gastrointestinal symptoms and are more likely to present with a shock-like presentation. Moreover, they often present with cardiovascular involvement including myocardial dysfunction, valvulitis, and coronary artery dilation or aneurysms. Here, we present a review of the literature and summary of our current understanding of cardiovascular involvement in children with COVID-19 or MIS-C and identifying the role of a pediatric cardiologist in caring for these patients.
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Affiliation(s)
- Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kyle Hope
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Michael Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, New York, USA
| | - Nilanjana Misra
- Pediatric Cardiology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Carrie Altman
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Julie Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, New York, USA
| | | | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton and Harefield Hospitals Trust, National Heart and Lung Institute, Imperial College, London, UK
| | - Jacob Miller
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA
| | - Christopher Snyder
- Pediatric Cardiology, Rainbow Babies and Children's Hospital, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Devyani Chowdhury
- Cardiology Care for Children, 1834 Oregon Pike, Ste 20, Lancaster, PA, 17601, USA.
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153
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Neurologic complications of cardiac disease in athletes. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:269-274. [PMID: 33632446 DOI: 10.1016/b978-0-12-819814-8.00031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Athletic participation at all levels of proficiency is an encouraged activity. Physicians evaluating athletes are tasked with assessing the benefits and risks of participating in vigorous physical activity and should engage in shared decision making with the athlete. Identifying the neurologic sequelae is an essential part of the assessment that is often not covered. This chapter will review the association of a wide range of cardiac disorders that can be related to or associated with subsequent neurologic sequelae, along with a brief overview of recommendations for management. Prevalent neurological complications of cardiac disease in athletes include stroke and seizures. There are also certain channelopathies that result in concurrent cardiac dysrhythmias and epilepsy. In addition, physiologic cardiac rhythm changes and the athlete's heart are discussed in the context of the differential diagnoses of subsequent cardiac and neurologic disease. The primary objective of this chapter is to prepare the physician for accurate recognition of cardiac disease in athletes that could result in neurologic complications if not diagnosed and managed early on.
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154
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van Hattum JC, Verwijs SM, Rienks R, Bijsterveld NR, de Vries ST, Pinto YM, Wilde AAM, Jørstad HT. The Netherlands Sports Cardiology Map: a step towards sports cardiology network medicine for patient and athlete care. Neth Heart J 2020; 29:129-134. [PMID: 33355906 PMCID: PMC7904973 DOI: 10.1007/s12471-020-01530-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 12/22/2022] Open
Abstract
Sports cardiology is a rapidly evolving subspecialty of cardiology, with a growing demand for expertise. To improve patient care, clinicians, patients, and athletes (recreational to elite) should be able to easily identify specialised care pathways, expertise centres and clinicians with sports cardiology expertise. To this purpose, several international societies and organisations recommend establishing a local and national sports cardiology infrastructure. We therefore aimed to establish The Netherlands Sports Cardiology Map. We conducted a web-based survey, which was published on the Netherlands Society of Cardiology home page (2019–2020) and in which each cardiology department or clinic was asked to provide information on sports cardiology expertise and the current infrastructure. Of the 46 respondent centres, 28 (61%) reported that they had expertise in sports cardiology, of which 22 (79%) had specific expertise in one or more specific types of sports. Integrated multidisciplinary meetings were reported by 43% of the centres (n = 12/28). Only two centres reported ongoing research projects that had been approved by an institutional review board. The Netherlands Sports Cardiology Map is an important step towards improving the existing infrastructure and developing network medicine for sports cardiology.
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Affiliation(s)
- J C van Hattum
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - S M Verwijs
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - R Rienks
- CardioExpert, Amsterdam, The Netherlands
| | - N R Bijsterveld
- Department of Cardiology, Flevo Hospital, Almere, The Netherlands
| | - S T de Vries
- Department of Cardiology, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Y M Pinto
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A A M Wilde
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - H T Jørstad
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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155
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2020; 76:3022-3055. [PMID: 33229115 DOI: 10.1016/j.jacc.2020.08.044] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. STRUCTURE Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
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156
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2020; 142:e533-e557. [PMID: 33215938 DOI: 10.1161/cir.0000000000000938] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aim This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. Methods A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Structure Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
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Affiliation(s)
| | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
- HFSA Representative
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157
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[ESC guidelines on sports cardiology 2020 : Which sports can be performed with heart diseases?]. Herz 2020; 46:38-45. [PMID: 33336289 DOI: 10.1007/s00059-020-05008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
The guidelines for sports cardiology have recently been published for the first time by the European Society of Cardiology (ESC). They address recommendations for leisure time exercise and competitive sports in athletes with cardiovascular diseases. The spectrum ranges from women during pregnancy, athletes with increased cardiovascular risk and risk factors or with a genetic predisposition, such as ion channelopathies, cardiomyopathies, congenital heart diseases as well as patients with valvular heart diseases, coronary heart disease, after myocardial infarction, with arrhythmia and with heart failure. A detailed cardiological evaluation of the athlete with heart disease is the basis for detailed and individually tailored recommendations with respect to the type of sport, mode, duration and intensity of physical exercise, physical training and the capability for competitive sports. Evidence from the current literature and the experience of the sports cardiologist are the basis for shared decision making between the sports cardiologist and the athlete/patient, which is becoming increasingly more important. Together, they will decide which sport can be practiced defining intensity and duration.
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158
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D'Ascenzi F, Biella F, Lemme E, Maestrini V, Di Giacinto B, Pelliccia A. Female Athlete's Heart: Sex Effects on Electrical and Structural Remodeling. Circ Cardiovasc Imaging 2020; 13:e011587. [PMID: 33317335 DOI: 10.1161/circimaging.120.011587] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Most of our knowledge on training-induced cardiac remodeling is derived from men, with the paucity of data from women representing an important gap in knowledge. The aim of the study was to define the electrocardiographic and morphological features of female athlete's heart, with special attention to differences related to sex and sport. METHODS Seven hundred twenty Olympic athletes (360 females and 360 age- and sport-matched males, mean age: 23±5 years) were evaluated by clinical, resting, and exercise electrocardiography and echocardiography. RESULTS Anterior T-wave inversion was more common in females than males (P<0.05). Left ventricular (LV) wall thickness and LV mass were greater in men (P<0.001). Females had smaller absolute but greater indexed LV and right ventricular (RV) dimensions as compared to males. Most women had normal LV geometry (80.8%). A progressive increase in LV/RV dimensions was observed in women from those engaged in skill, power, to mixed and endurance disciplines, with the endurance ones demonstrating the greatest degree of RV dilatation. Women had a peculiar biventricular adaptation, with higher LV/RV (1.41±0.16 versus 1.36±0.15, P<0.0001) and lower RV inflow/outflow ratio (P<0.001), as compared to men. CONCLUSIONS Sex significantly affects cardiac remodeling in athletes, with females presenting a different electrical and structural remodeling. Women maintain a normal LV geometry, with relative larger increase of cavity dimensions compared with men. Type of sport has a relevant impact, with endurance athletes exhibiting the greatest degree of RV and LV dimensional remodeling. The present study confirms the need for a sex-based approach for interpreting the complex features of athlete's heart in women.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy (F.D.)
| | - Federico Biella
- Institute of Sports Medicine and Science, Rome, Italy (F.B., E.L., V.M., B.D.G., A.P.)
| | - Erika Lemme
- Institute of Sports Medicine and Science, Rome, Italy (F.B., E.L., V.M., B.D.G., A.P.)
| | - Viviana Maestrini
- Institute of Sports Medicine and Science, Rome, Italy (F.B., E.L., V.M., B.D.G., A.P.)
| | - Barbara Di Giacinto
- Institute of Sports Medicine and Science, Rome, Italy (F.B., E.L., V.M., B.D.G., A.P.)
| | - Antonio Pelliccia
- Institute of Sports Medicine and Science, Rome, Italy (F.B., E.L., V.M., B.D.G., A.P.)
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159
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Femia G, Semsarian C, Ross SB, Celermajer D, Puranik R. Left Ventricular Non-Compaction: Review of the Current Diagnostic Challenges and Consequences in Athletes. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E697. [PMID: 33327510 PMCID: PMC7764920 DOI: 10.3390/medicina56120697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022]
Abstract
Left ventricular non-compaction (LVNC) is a complex clinical condition with no diagnostic gold standard. At present, there is trepidation about the accuracy of the diagnosis, the correlation to clinical outcomes and the long-term medical management. This article reviews the current imaging criteria, the limitations of echocardiography and cardiac magnetic resonance and the consequences of LV hypertrabeculation in athletes.
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Affiliation(s)
- Giuseppe Femia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
| | - Christopher Semsarian
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute, Camperdown 2050, Australia
| | - Samantha B. Ross
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - David Celermajer
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | - Rajesh Puranik
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (C.S.); (S.B.R.); (D.C.); (R.P.)
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown 2050, Australia
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160
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Phelan D, Kim JH, Elliott MD, Wasfy MM, Cremer P, Johri AM, Emery MS, Sengupta PP, Sharma S, Martinez MW, La Gerche A. Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement. JACC Cardiovasc Imaging 2020; 13:2635-2652. [PMID: 33303102 PMCID: PMC7598679 DOI: 10.1016/j.jcmg.2020.10.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
As our understanding of the complications of coronavirus disease-2019 (COVID-19) evolve, subclinical cardiac pathology such as myocarditis, pericarditis, and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern. The potential implications of these findings in athletes are significant given the concern that exercise, during the acute phase of viral myocarditis, may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias. Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID-19 in order to permit safe return to play. Cardiac imaging is at the center of these evaluations. This review seeks to evaluate the current evidence regarding COVID-19-associated cardiovascular disease and how multimodality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection. Guidance is provided with diagnostic "red flags" that raise the suspicion of pathology. Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from subclinical cardiac disease. The strengths and limitations of different imaging modalities are discussed and an approach to return to play decision making for athletes post-COVID-19, as informed by multimodality imaging, is provided.
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Affiliation(s)
- Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA.
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory School of Medicine, Atlanta, Georgia, USA
| | - Michael D Elliott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Meagan M Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Cremer
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amer M Johri
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Michael S Emery
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University Hospital, London, United Kingdom
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Morristown Medical Center, Atlantic Health, Morristown, New Jersey, USA
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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161
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McKinney J, Connelly KA, Dorian P, Fournier A, Goodman JM, Grubic N, Isserow S, Moulson N, Philippon F, Pipe A, Poirier P, Taylor T, Thornton J, Wilkinson M, Johri AM. COVID-19-Myocarditis and Return to Play: Reflections and Recommendations From a Canadian Working Group. Can J Cardiol 2020; 37:1165-1174. [PMID: 33248208 PMCID: PMC7688421 DOI: 10.1016/j.cjca.2020.11.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19–related pandemic has resulted in profound health, financial, and societal impacts. Organized sporting events, from recreational to the Olympic level, have been cancelled to both mitigate the spread of COVID-19 and protect athletes and highly active individuals from potential acute and long-term infection-associated harms. COVID-19 infection has been associated with increased cardiac morbidity and mortality. Myocarditis and late gadolinium enhancement as a result of COVID-19 infection have been confirmed. Correspondingly, myocarditis has been implicated in sudden cardiac death of athletes. A pragmatic approach is required to guide those who care for athletes and highly active persons with COVID-19 infection. Members of the Community and Athletic Cardiovascular Health Network (CATCHNet) and the writing group for the Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes recommend that highly active persons with suspected or confirmed COVID-19 infection refrain from exercise for 7 days after resolution of viral symptoms before gradual return to exercise. We do not recommend routine troponin testing, resting 12-lead electrocardiography, echocardiography, or cardiac magnetic resonance imaging before return to play. However, medical assessment including history and physical examination with consideration of resting electrocardiography and troponin can be considered in the athlete manifesting new active cardiac symptoms or a marked reduction in fitness. If concerning abnormalities are encountered at the initial medical assessment, then referral to a cardiologist who cares for athletes is recommended.
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Affiliation(s)
- James McKinney
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Kim A Connelly
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, University of Montréal, Montréal, Québec, Canada
| | - Jack M Goodman
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Grubic
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Saul Isserow
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel Moulson
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - François Philippon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Taryn Taylor
- Department of Sports Medicine, Carleton Sport Medicine Clinic, Ottawa, Ontario, Canada
| | - Jane Thornton
- Department of Sports Medicine, Western University, London, Ontario, Canada
| | - Mike Wilkinson
- Department of Sports Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amer M Johri
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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162
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Affiliation(s)
- Andrew D'Silva
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK .,School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Bjarke Jensen
- Department of Medical Biology, University of Amsterdam, Amsterdam, The Netherlands
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163
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Abstract
Ischemic heart disease and non-ischemic dilated cardiomyopathy are the most common causes of arrhythmic sudden cardiac death (SCD). Implantable cardioverter defibrillator (ICD) therapy is the only strategy that proved to be effective in preventing SCD in high-risk individuals while the role of antiarrhythmic drugs is limited to symptoms relief. Current guidelines recommend selecting candidates to ICD implantation based on etiology, symptoms of heart failure (NYHA class), and severely depressed left ventricular ejection fraction, but these parameters are neither sensitive nor specific. The review addresses the mechanisms of SCD in patients with heart failure of either ischemic or non-ischemic etiology, risk stratification, and strategies for prevention of SCD in the clinical practice (including optimization of heart failure therapy, avoidance of triggering factors, antiarrhythmic drugs, ICD therapy, early resuscitation, and public access defibrillators).
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Affiliation(s)
- Domenico Corrado
- Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121, Padova, Italy.
| | - Alessandro Zorzi
- Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121, Padova, Italy
| | - Emilio Vanoli
- Molecular Medicine Department, Università degli Studi di Pavia, Pavia, Italy.,Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Edoardo Gronda
- Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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164
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Hurwitz B, Issa O. Management and Treatment of Myocarditis in Athletes. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:65. [PMID: 33169059 PMCID: PMC7609375 DOI: 10.1007/s11936-020-00875-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/22/2022]
Abstract
Purpose of review Myocarditis is an inflammation of the myocardium that can often be associated with cardiac dysfunction and arrhythmias, and is even one of the leading causes for sudden cardiac death (SCD) in athletes. This review aims to summarize the current evidence and treatment guidelines for the management of myocarditis in the active population. Recent findings Physical exertion is likely a trigger for dangerous arrythmias and further propagates myocardial damage in athletes with myocarditis. For this reason, abstinence from sports is a critical facet of management in the initial inflammatory period. The use of cardiac magnetic resonance imaging, specifically late gadolinium enhancement, to guide return to play decisions is becoming more common in clinical practice. Summary Establishing a stepwise approach for proper diagnosis and risk stratification, with an emphasis on contemporary cardiac magnetic resonance (CMR) imaging techniques, in myocarditis is critical. After a diagnosis of myocarditis is made, it is imperative for any athlete or highly active individual to refrain from physical exercise. Additionally, therapy for heart failure should be applied in cases of myocarditis with cardiac dysfunction. Undoubtedly, COVID 19, and its potential to cause myocarditis, is sure to change the landscape of management of this disease.
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Affiliation(s)
- Benjamin Hurwitz
- Department of Cardiology, Mount Sinai-Miami, Miami Beach, FL USA
| | - Omar Issa
- Department of Cardiology, Mount Sinai-Miami, Miami Beach, FL USA
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165
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El Masri I, Kayali SM, Blount C, Kirolos I, Khouzam JP, Kabra R. Is Exercise Helpful or Harmful in Dealing With Specific Arrhythmia. Curr Probl Cardiol 2020; 46:100740. [PMID: 33213943 DOI: 10.1016/j.cpcardiol.2020.100740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
Exercise is universally known to benefit health by lowering risk for cardiovascular disease and mortality. However, in patients with pre-existing cardiac conditions, including channelopathies, cardiomyopathies and coronary artery disease, exercise can cause sudden cardiac death (SCD). In this review, we explore exercise related risks and current recommendations for specific conditions. The risk of myocardial infarction (MI) during strenuous exercise in asymptomatic individuals with coronary artery disease is decreased with habitual exercise, especially if they have a normal ejection fraction and no ischemia. Furthermore, cardiac rehabilitation has been shown to be beneficial in heart failure. On the other hand, surgery is recommended for certain anomalous coronaries prior to engaging in vigorous activity. In addition, both exercise-induced disease progression and SCD in arrhythmogenic cardiomyopathy restrict ability to engage in competitive sports, as is the case in hypertrophic cardiomyopathy. Other diseases, like myocarditis only cause temporary risk for SCD. Previously considered benign, common conditions like early repolarization do increase SCD risk. Finally, certain gear including thicker chest protectors for athletes engaging in sports with hard, small spherical objects decrease risk of commotio cordis. While significant advances have been achieved in diagnosing and treating previously unrecognized conditions that predispose to sudden cardiac death, more research is needed to further tailor recommendations to allow beneficial exercise in those with rarer conditions that are under-represented in large systemic studies.
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167
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Metzl JD, McElheny K, Robinson JN, Scott DA, Sutton KM, Toresdahl BG. Considerations for Return to Exercise Following Mild-to-Moderate COVID-19 in the Recreational Athlete. HSS J 2020; 16:102-107. [PMID: 32837412 PMCID: PMC7416806 DOI: 10.1007/s11420-020-09777-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has resulted in significant morbidity and mortality around the world. The spectrum of COVID-19 is broad, from clinical disease requiring intensive medical care to less severe symptoms that are treated with supportive care. The majority of COVID-19 cases fall into the mild-to-moderate category, with symptoms lasting less than 6 weeks. Nevertheless, the morbidity from COVID-19 is significant and can affect multiple body systems, most frequently the cardiac, pulmonary, hematologic, musculoskeletal, and gastrointestinal systems. For patients who wish to return to exercise after mild-to-moderate COVID-19, the wide range of disease expression presents a challenge for clinicians seeking to offer counsel. This literature review on return to activity following mild to moderate COVID-19 in the recreational athlete includes evidence-based considerations and recommendations for clinicians in guiding the safest return to activity.
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Affiliation(s)
- Jordan D. Metzl
- Sports Medicine Institute, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Kathryn McElheny
- Sports Medicine Institute, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - James N. Robinson
- Sports Medicine Institute, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Daphne A. Scott
- Sports Medicine Institute, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Karen M. Sutton
- Sports Medicine Institute, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Brett G. Toresdahl
- Sports Medicine Institute, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
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168
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Affiliation(s)
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
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169
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Fabre JB, Grelot L, Vanbiervielt W, Mazerie J, Manca R, Martin V. Managing the combined consequences of COVID-19 infection and lock-down policies on athletes: narrative review and guidelines proposal for a safe return to sport. BMJ Open Sport Exerc Med 2020; 6:e000849. [PMID: 33194223 PMCID: PMC7610250 DOI: 10.1136/bmjsem-2020-000849] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/04/2020] [Accepted: 10/03/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pandemic is a global health matter. The disease spread rapidly across the globe and brought the world of sports to an unprecedented stoppage. Usual symptoms of the disease are fever, cough, myalgia, fatigue, slight dyspnoea, sore throat and headache. In more severe cases, dyspnoea, hypoxaemia, respiratory failure, shock and multiorgan failure occur. This appears to be a self-limiting phenomenon related to individuals with coexisting medical conditions, such as hypertension, diabetes and cardiovascular disorders. Nevertheless, cases have been reported in professional soccer players in extremely good fitness condition, demonstrating that athletes are not spared by the disease. Despite COVID-19 clinical manifestations are mainly respiratory, major cardiac complications are being reported, leading to acute myocarditis. One difficulty is that symptoms of COVID-19 vary among individuals, with athletes being affected with no apparent sign of the disease. This could be a real danger for amateur or professional athletes when returning to their usual training and thus to play. Another threat is that the lock-down policies did not allow most athletes to follow their usual training routines. There is thus a need for a careful approach by the sports medicine community to ensure safety of all athletes before they return to sport. Here, we propose evaluation guidelines of fitness and health of athletes to (1) reduce any lethal risk of practice, especially myocarditis and sudden cardiac death; (2) evaluate the combined consequences of the disease and detraining on the physical abilities and biological profile of athletes; and (3) monitor postinfection fatigue symptoms.
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Affiliation(s)
| | - Laurent Grelot
- Health and Safety Department, Aix-Marseille-University,Marseille, France
| | | | | | - Raphael Manca
- Institut Universitaire de France (IUF), Paris, France
| | - Vincent Martin
- Université Clermont Auvergne, AME2P, Clermont-Ferrand,France
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170
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Abstract
PURPOSE OF REVIEW Dilated cardiomyopathy (DCM) frequently involves an underlying genetic etiology, but the clinical approach for genetic diagnosis and application of results in clinical practice can be complex. RECENT FINDINGS International sequence databases described the landscape of genetic variability across populations, which informed guidelines for the interpretation of DCM gene variants. New evidence indicates that loss-of-function mutations in filamin C (FLNC) contribute to DCM and portend high risk of ventricular arrhythmia. A clinical framework aids in referring patients for DCM genetic testing and applying results to patient care. Results of genetic testing can change medical management, particularly in a subset of genes that increase risk for life-threatening ventricular arrhythmias, and can influence decisions for defibrillator therapy. Clinical screening and cascade genetic testing of family members should be diligently pursued to identify those at risk of developing DCM.
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Affiliation(s)
- Lisa D Wilsbacher
- Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Simpson Querrey Biomedical Research Center 8-404, 303 E. Superior St, Chicago, IL, 60611, USA.
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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171
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Li COY, Roston TM, MacEwing C, Sanatani S. To play or not to play? sports participation and shared decision-making in athletes with inherited heart rhythm disorders. Br J Sports Med 2020; 54:1126-1128. [DOI: 10.1136/bjsports-2019-101236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 01/02/2023]
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172
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Yozgat CY, Yesilbas O, Iscan A, Yurtsever I, Temur HO, Bayramova N, Ergun G, Tekin N, Yozgat Y. Development of Antiarrhythmic Therapy-Resistant Ventricular Tachycardia, Ventricular Fibrillation, and Premature Ventricular Contractions in a 15-Year-Old Patient. J Pediatr Intensive Care 2020; 11:72-76. [DOI: 10.1055/s-0040-1715851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022] Open
Abstract
AbstractSudden cardiac arrest (SCA) is the sudden cessation of regular cardiac activity so that the victim becomes unresponsive, with no signs of circulation and no normal breathing. Asystole, ventricular tachycardia (VT), ventricular fibrillation (VF), and pulseless electrical activity are the underlying rhythm disturbances in the pediatric age group. If appropriate interventions (cardiopulmonary resuscitation-CPR and/or defibrillation or cardioversion) are not performed rapidly, this condition progresses to sudden death. There have not been many reported cases of the approach and treatment of cardiac arrhythmias after SCA. Herein, we would like to report a case of a 15-year-old female patient with dilated cardiomyopathy (DCM) who was admitted to our clinic a year ago, and while her left ventricular systolic functions were improved, SCA suddenly occurred. Since the SCA event occurred in another city, intravenous treatment of amiodarone was done immediately and was switch to continuous infusion dose of amiodarone until the patient arrived at our institution's pediatric intensive care unit (PICU) 3 hours later. During the patient's 20-day PICU hospitalization, she developed pulseless VT and VF from time to time. The patient's pulseless VT and VF attacks were brought under control by the use of a defibrillator and added antiarrhythmic drugs (amiodarone, flecainide, esmolol, and propafenone). Intriguingly, therapy-resistance bigeminy with premature ventricular contractions (PVCs) continued despite all these treatments. The patient did not have adequate blood pressure measured by invasive arterial blood pressure monitoring while having bigeminy PVCs. The intermittent bigeminy PVCs ameliorated rapidly after intermittent boluses of lidocaine. In the end, multiple antiarrhythmic therapies and intermittent bolus lidocaine doses were enough to bring her cardiac arrhythmias after SCA under control. This case illustrates that malign PVC's should be taken very seriously, since they may predispose to the development of VT or VF. Also, this case highlights the importance of close vigilance of arterial pressure tracings of patients with bigeminy PVCs which develop after SCA and should not be accepted as normal.
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Affiliation(s)
| | - Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Akin Iscan
- Department of Pediatric Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ismail Yurtsever
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Nigar Bayramova
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Gokce Ergun
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Nur Tekin
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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173
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(Right ventricle in athletes). COR ET VASA 2020. [DOI: 10.33678/cor.2020.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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174
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175
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Společné odborné stanovisko Sekce sportovní kardiologie České asociace preventivní kardiologie ČKS a Sekce sportovní kardiologie České společnosti tělovýchovného lékařství. COR ET VASA 2020. [DOI: 10.33678/cor.2020.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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176
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(Hypertrophic cardiomyopathy and sports - is it time for a change in strategy?). COR ET VASA 2020. [DOI: 10.33678/cor.2020.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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177
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Canepa M, Fumagalli C, Tini G, Vincent-Tompkins J, Day SM, Ashley EA, Mazzarotto F, Ware JS, Michels M, Jacoby D, Ho CY, Olivotto I. Temporal Trend of Age at Diagnosis in Hypertrophic Cardiomyopathy: An Analysis of the International Sarcomeric Human Cardiomyopathy Registry. Circ Heart Fail 2020; 13:e007230. [PMID: 32894986 PMCID: PMC7497482 DOI: 10.1161/circheartfailure.120.007230] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Over the last 50 years, the epidemiology of hypertrophic cardiomyopathy (HCM) has changed because of increased awareness and availability of advanced diagnostic tools. We aim to describe the temporal trends in age, sex, and clinical characteristics at HCM diagnosis over >4 decades. Methods: We retrospectively analyzed records from the ongoing multinational Sarcomeric Human Cardiomyopathy Registry. Overall, 7286 patients with HCM diagnosed at an age ≥18 years between 1961 and 2019 were included in the analysis and divided into 3 eras of diagnosis (<2000, 2000–2010, >2010). Results: Age at diagnosis increased markedly over time (40±14 versus 47±15 versus 51±16 years, P<0.001), both in US and non-US sites, with a stable male-to-female ratio of about 3:2. Frequency of familial HCM declined over time (38.8% versus 34.3% versus 32.7%, P<0.001), as well as heart failure symptoms at presentation (New York Heart Association III/IV: 18.1% versus 15.8% versus 12.6%, P<0.001). Left ventricular hypertrophy became less marked over time (maximum wall thickness: 20±6 versus 18±5 versus 17±5 mm, P<0.001), while prevalence of obstructive HCM was greater in recent cohorts (peak gradient >30 mm Hg: 31.9% versus 39.3% versus 39.0%, P=0.001). Consistent with decreasing phenotypic severity, yield of pathogenic/likely pathogenic variants at genetic testing decreased over time (57.7% versus 45.6% versus 38.4%, P<0.001). Conclusions: Evolving HCM populations include progressively greater representation of older patients with sporadic disease, mild phenotypes, and genotype-negative status. Such trend suggests a prominent role of imaging over genetic testing in promoting HCM diagnoses and urges efforts to understand genotype-negative disease eluding the classic monogenic paradigm.
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Affiliation(s)
- Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Italy (M.C., G.T.)
| | - Carlo Fumagalli
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (C.F., F.M., I.O.)
| | - Giacomo Tini
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Italy (M.C., G.T.)
| | | | - Sharlene M Day
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.M.D.)
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, CA (E.A.A.)
| | - Francesco Mazzarotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (C.F., F.M., I.O.).,National Heart and Lung Institute and National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit, Imperial College London, United Kingdom (F.M., J.S.W.)
| | - James S Ware
- National Heart and Lung Institute and National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit, Imperial College London, United Kingdom (F.M., J.S.W.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | | | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (C.F., F.M., I.O.)
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178
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Santos-Ferreira D, Tomás R, Dores H. TEAM to Defeat COVID-19: A Management Strategy Plan to Address Return to Play in Sports Medicine. Orthop J Sports Med 2020; 8:2325967120951453. [PMID: 32944588 PMCID: PMC7469729 DOI: 10.1177/2325967120951453] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/28/2020] [Indexed: 01/10/2023] Open
Abstract
A new viral disease named COVID-19 spread rapidly into a pandemic in early 2020. Most countries have active community transmission and imposed measures such as social distancing and travel restrictions to mitigate its effect. Many sporting events all over the globe were canceled or postponed. In this article, we briefly discuss some important topics regarding the COVID-19 pandemic and propose a strategy to manage return to play in professional athletes. We searched the PubMed and Google Scholar databases to identify articles published through May 12, 2020, using the following keywords: "coronavirus," "COVID-19," "SARS-CoV-2," "athlete," and "return to play." Although athletes have a lower risk of severe disease, preventive measures are still very important for minimizing time away from training, avoiding potential complications, slowing the pandemic spread, and ultimately protecting the health of those with a higher risk of complications and death. Athletes may present with mild disease, but complications such as pulmonary fibrosis and myocardial injuries have to be considered. Although still controversial, athletes should be evaluated before return to play and monitored accordingly afterward via proper clinical assessments and testing.
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Affiliation(s)
- Diana Santos-Ferreira
- Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Rita Tomás
- Portugal Football School, Portuguese Football Federation, Oeiras, Portugal
- Clínica CUF Alvalade, Lisbon, Portugal
| | - Hélder Dores
- Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
- Cardiology Department, Hospital da Luz, Lisbon, Portugal
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179
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Grossman GB, Sellera CAC, Hossri CAC, Carreira LTF, Avanza AC, Albuquerque PFD, Milani M, Mastrocola LE, Ritt LEF, Freitas OGAD, Carvalho TD, Chalela WA, Ghorayeb N, Meneghelo RS, Nunes MB, Serra SM. Position Statement of the Brazilian Society of Cardiology Department of Exercise Testing, Sports Exercise, Nuclear Cardiology, and Cardiovascular Rehabilitation (DERC/SBC) on Activities Within its Scope of Practice During the COVID-19 Pandemic. Arq Bras Cardiol 2020; 115:284-291. [PMID: 32876199 PMCID: PMC8384272 DOI: 10.36660/abc.20200797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
- Clínica Cardionuclear, Porto Alegre, RS - Brasil
| | - Carlos Alberto Cyrillo Sellera
- Santa Casa de Misericórdia de Santos, Santos, SP - Brasil
- Faculdade de Medicina da Universidade Metropolitana de Santos, Santos, SP - Brasil
| | | | - Lara Terra F Carreira
- Hospital Nossa Senhora do Pilar, Curitiba, PR - Brasil
- Cardiologia Nuclear Curitiba, Curitiba, PR - Brasil
| | - Antônio Carlos Avanza
- Universidade Vila Velha, Vitória, ES - Brasil
- Clínica Centrocor, Vitória, ES - Brasil
| | | | | | | | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Hospital Cardiopulmonar, Salvador, BA - Brasil
| | | | - Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
- Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFM-USP),São Paulo, SP - Brasil
- Sociedade Beneficente de Senhoras Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Nabil Ghorayeb
- Hospital do Coração (Hcor), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | - Romeu Sergio Meneghelo
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Salvador Manoel Serra
- Centro de Cardiologia do Exercício do Instituto Estadual de Cardiologia Aloysio de Castro (CCEx/IECAC), Rio de Janeiro, RJ - Brasil
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180
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | | | - Christine A'Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Maria Buxton
- West Hertfordshire Respiratory Service - Central London Community Healthcare, London, UK
| | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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181
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Basu J, Malhotra A, Papadakis M. Exercise and hypertrophic cardiomyopathy: Two incompatible entities? Clin Cardiol 2020; 43:889-896. [PMID: 32048747 PMCID: PMC7403677 DOI: 10.1002/clc.23343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 01/02/2023] Open
Abstract
A greater understanding of the pathogenic mechanisms underpinning hypertrophic cardiomyopathy (HCM) has translated to improved medical care and better survival of affected individuals. Historically these patients were considered to be at high risk of sudden cardiac death (SCD) during exercise; therefore, exercise recommendations were highly conservative and promoted a sedentary life style. There is emerging evidence that suggests that exercise in HCM has a favorable effect on cardiovascular remodeling and moderate exercise programs have not raised any safety concerns. Furthermore, individuals with HCM have a similar burden of atherosclerotic risk factors as the general population in whom exercise has been associated with a reduction in myocardial infarction, stroke, and heart failure, especially among those with a high-risk burden. Small studies revealed that athletes who choose to continue with regular competition do not demonstrate adverse outcomes when compared to those who discontinue sport, and active individuals implanted with an implantable cardioverter defibrillator do not have an increased risk of appropriate shocks or other adverse events. The recently published exercise recommendations from the European Association for Preventative Cardiology account for more contemporary evidence and adopt a more liberal stance regarding competitive and high intensity sport in individuals with low-risk HCM. This review addresses the issue of exercise in individuals with HCM, and explores current evidence supporting safety of exercise in HCM, potential caveats, and areas of further research.
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Affiliation(s)
- Joyee Basu
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
| | - Aneil Malhotra
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
- Division of Cardiovascular SciencesThe University of ManchesterManchesterUK
| | - Michael Papadakis
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
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182
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Gasperetti A, Dello Russo A, Busana M, Dessanai M, Pizzamiglio F, Saguner AM, te Riele AS, Sommariva E, Vettor G, Bosman L, Duru F, Zeppilli P, Di Biase L, Natale A, Tondo C, Casella M. Novel risk calculator performance in athletes with arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2020; 17:1251-1259. [DOI: 10.1016/j.hrthm.2020.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
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183
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Bhatia RT, Marwaha S, Malhotra A, Iqbal Z, Hughes C, Börjesson M, Niebauer J, Pelliccia A, Schmied C, Serratosa L, Papadakis M, Sharma S. Exercise in the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) era: A Question and Answer session with the experts Endorsed by the section of Sports Cardiology & Exercise of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2020; 27:1242-1251. [PMID: 32475157 PMCID: PMC7717284 DOI: 10.1177/2047487320930596] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Abstract
Regular exercise has multiple benefits for physical and mental health, including the body's ability to combat infections. The current COVID-19 pandemic and the social distancing measures employed to curtail the impact of the infection are likely to reduce the amount of usual physical activity being performed by most individuals, including habitual exercisers. The uncertainties relating to the impact of the SARS-CoV-2 virus on the heart may cause increased anxiety, particularly in athletes who need to sustain a vigorous exercise regime in order to maintain their skills and fitness in preparation for return to competition after a short re-training period. The aim of this document is to provide practical answers to pertinent questions being posed by the sporting community, in an attempt to offer reassurance, promote safe participation in exercise during as well as after the COVID-19 pandemic and provide a framework of management for physicians caring for athletes.
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Affiliation(s)
- Raghav T Bhatia
- />Cardiology Clinical Academic Group, St George’s, University of London, UK
| | - Sarandeep Marwaha
- />Cardiology Clinical Academic Group, St George’s, University of London, UK
| | - Aneil Malhotra
- />Division of Cardiovascular Science, University of Manchester, Manchester University NHS Foundation Trust, UK
| | - Zafar Iqbal
- />Department of Sports Medicine, Crystal Palace FC, London, UK
| | | | - Mats Börjesson
- />Department of Molecular and Clinical Medicine Institute of Medicine, Centre for Health and Performance, Gothenburg University and Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - Josef Niebauer
- />Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Austria
| | | | | | - Luis Serratosa
- />Hospital Universitario Quironsalud Madrid, Spain *These authors contributed jointly as senior authors
| | - Michael Papadakis
- />Cardiology Clinical Academic Group, St George’s, University of London, UK
| | - Sanjay Sharma
- />Cardiology Clinical Academic Group, St George’s, University of London, UK
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184
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Barker-Davies RM, O'Sullivan O, Senaratne KPP, Baker P, Cranley M, Dharm-Datta S, Ellis H, Goodall D, Gough M, Lewis S, Norman J, Papadopoulou T, Roscoe D, Sherwood D, Turner P, Walker T, Mistlin A, Phillip R, Nicol AM, Bennett AN, Bahadur S. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med 2020; 54:949-959. [PMID: 32475821 PMCID: PMC7418628 DOI: 10.1136/bjsports-2020-102596] [Citation(s) in RCA: 349] [Impact Index Per Article: 87.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 02/06/2023]
Abstract
The highly infectious and pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2, has emerged causing a global pandemic. Although COVID-19 predominantly affects the respiratory system, evidence indicates a multisystem disease which is frequently severe and often results in death. Long-term sequelae of COVID-19 are unknown, but evidence from previous CoV outbreaks demonstrates impaired pulmonary and physical function, reduced quality of life and emotional distress. Many COVID-19 survivors who require critical care may develop psychological, physical and cognitive impairments. There is a clear need for guidance on the rehabilitation of COVID-19 survivors. This consensus statement was developed by an expert panel in the fields of rehabilitation, sport and exercise medicine (SEM), rheumatology, psychiatry, general practice, psychology and specialist pain, working at the Defence Medical Rehabilitation Centre, Stanford Hall, UK. Seven teams appraised evidence for the following domains relating to COVID-19 rehabilitation requirements: pulmonary, cardiac, SEM, psychological, musculoskeletal, neurorehabilitation and general medical. A chair combined recommendations generated within teams. A writing committee prepared the consensus statement in accordance with the appraisal of guidelines research and evaluation criteria, grading all recommendations with levels of evidence. Authors scored their level of agreement with each recommendation on a scale of 0-10. Substantial agreement (range 7.5-10) was reached for 36 recommendations following a chaired agreement meeting that was attended by all authors. This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post COVID-19 illness, for a target population of active individuals, including military personnel and athletes.
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Affiliation(s)
- Robert M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK oliver.o'
- Headquarters Army Medical Directorate, Camberley, UK
| | - Kahawalage Pumi Prathima Senaratne
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- Department of Sport and Exercise Medicine, Queen's Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Polly Baker
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- University of Brighton, Brighton, East Sussex, UK
| | - Mark Cranley
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Shreshth Dharm-Datta
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Henrietta Ellis
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Duncan Goodall
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- Medical Department, Nottinghamshire County Cricket Club, Nottingham, UK
| | - Michael Gough
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Sarah Lewis
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Jonathan Norman
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Theodora Papadopoulou
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- British Association of Sport and Exercise Medicine, Doncaster, UK
| | - David Roscoe
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Daniel Sherwood
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Philippa Turner
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- Medical School, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Tammy Walker
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Alan Mistlin
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Rhodri Phillip
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Alastair M Nicol
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- FASIC Sport and Exercise Medicine Clinic, University of Edinburgh, Edinburgh, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, London, UK
| | - Sardar Bahadur
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
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185
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(Complex approach towards patients with hypertrophic cardiomyopathy and indications to genetic testing). COR ET VASA 2020. [DOI: 10.33678/cor.2020.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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186
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Verwoert GC, de Vries ST, Bijsterveld N, Willems AR, Vd Borgh R, Jongman JK, Kemps HMC, Snoek JA, Rienks R, Jorstad HT. Return to sports after COVID-19: a position paper from the Dutch Sports Cardiology Section of the Netherlands Society of Cardiology. Neth Heart J 2020; 28:391-395. [PMID: 32662058 PMCID: PMC7357275 DOI: 10.1007/s12471-020-01469-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to preventive measures worldwide. With the decline of infection rates, less stringent restrictions for sports and exercise are being implemented. COVID-19 is associated with significant cardiovascular complications; however there are limited data on cardiovascular complications and long-term outcomes in both competitive (elite) athletes and highly active individuals. Based on different categories of disease severity (asymptomatic, regional/systemic symptoms, hospitalisation, myocardial damage, and/or myocarditis), in this point-of-view article we offer the (sports) cardiologist or sports physician in the Netherlands a practical guide to pre-participation screening, and diagnostic and management strategies in all athletes >16 years of age after COVID-19 infection.
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Affiliation(s)
- G C Verwoert
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands. .,Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - S T de Vries
- Department of Cardiology, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - N Bijsterveld
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.,Department of Cardiology, Flevo Hospital, Almere, The Netherlands
| | - A R Willems
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | - R Vd Borgh
- Department of Cardiology, Laurentius Hospital, Roermond, The Netherlands
| | - J K Jongman
- Department of Cardiology, Wilhelmina Hospital, Assen, The Netherlands
| | - H M C Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands.,Department of Industrial Design, Technical University, Eindhoven, The Netherlands
| | - J A Snoek
- Department of Sports medicine, Isala, Zwolle, The Netherlands.,Isala Heart Centre, Zwolle, The Netherlands
| | - R Rienks
- Central Military Hospital, Utrecht, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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187
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Pieles GE, Stuart AG. The adolescent athlete's heart; A miniature adult or grown-up child? Clin Cardiol 2020; 43:852-862. [PMID: 32643161 PMCID: PMC7403711 DOI: 10.1002/clc.23417] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
The systematic development of early age talent in sports academies has led to the professionalization of pediatric sport and the sports physician need to be aware of pediatric cardiological problems. Research into the medical cardiac care and assessment of the pediatric athlete are accumulating, but specific pediatric international guidelines are not available yet and reference data for ECG and echocardiography are incomplete, in particular for the age group <12 years of age. This article is an introduction to the physiological and diagnostics specifics of the pediatric athlete. The focus lies in the differences in presentation and diagnosis between pediatric and adult athletes for the most common pathologies. Reference data for electrical and structural adaptations to intensive exercise are sparse particularly in athletes aged below 12 years old. Training related changes include decrease of resting heart rate, increase of cardiac output, ventricular cavity size, and wall thickness. Cardiac hypertrophy is less pronounced in pediatric athletes, as HR mediated cardiac output increase to endurance exercise is the dominant mechanism in peripubertal children. As in adults, the most pronounced cardiovascular adaptations appear in classical endurance sports like rowing, triathlon, and swimming, but the specifics of pediatric ECG and echocardiographic changes need to be considered.
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Affiliation(s)
- Guido E Pieles
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - A Graham Stuart
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
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188
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Oikonomou E, Papanikolaou A, Anastasakis A, Bournousouzis E, Georgakopoulos C, Goudevenos J, Ioakeimidis N, Kanakakis J, Lazaros G, Papatheodorou S, Tsatsopoulou A, Tsonou P, Vogiatzi G, Panagiotakopoulos G, Tousoulis D, Vlachopoulos C. Proposed algorithm for return to sports in competitive athletes who have suffered COVID-19. Hellenic J Cardiol 2020; 62:175-177. [PMID: 32634475 PMCID: PMC7335237 DOI: 10.1016/j.hjc.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- Evangelos Oikonomou
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Angelos Papanikolaou
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Greece
| | | | - Christos Georgakopoulos
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - John Goudevenos
- Department of Cardiology, University of Ioannina Medical School, Greece
| | - Nikolaos Ioakeimidis
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - John Kanakakis
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece
| | - George Lazaros
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Stathis Papatheodorou
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Greece
| | | | | | - Georgia Vogiatzi
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | | | - Dimitris Tousoulis
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Charalambos Vlachopoulos
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece.
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189
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Mascia G, Arbelo E, Porto I, Brugada R, Brugada J. The arrhythmogenic right ventricular cardiomyopathy in comparison to the athletic heart. J Cardiovasc Electrophysiol 2020; 31:1836-1843. [PMID: 32367567 DOI: 10.1111/jce.14526] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/25/2020] [Accepted: 04/24/2020] [Indexed: 01/02/2023]
Abstract
Intense exercise-induced right ventricular remodeling is a potential adaptation of cardiac function and structure. The features of the remodeling may overlap with those of a very early form of arrhythmogenic right ventricular cardiomyopathy (ARVC): at this early stage, it could be difficult to discriminate ARVC, from exercise-induced cardiac adaptation that may develop in normal individuals. The purpose of this paper is to discuss which exercise-induced remodeling may be a pathological or a physiological finding. A complete evaluation may be required to identify the pathological features of ARVC that would include potential risk of sudden cardiac death during sport or, to avoid the false diagnosis of ARVC. The most recent expert assessment of arrhythmogenic cardiomyopathy focuses on endurance athletes presenting with clinical features indistinguishable from ARVC.
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Affiliation(s)
- Giuseppe Mascia
- Department of Internal Medicine (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy.,Cardiology and Electrophysiology Unit, Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Institut d'Investigaciò August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Italo Porto
- Department of Internal Medicine (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), University of Girona, Girona, Spain
| | - Josep Brugada
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Institut d'Investigaciò August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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190
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Al-Zakhari R, Upadhya G, Galligan S, Shehaj F. The Myth of Colchicine in Treating Myopericarditis: Case Report and Literature Review. Cureus 2020; 12:e8933. [PMID: 32760633 PMCID: PMC7392355 DOI: 10.7759/cureus.8933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Myopericarditis is inflammation of the pericardium with concurrent myocardial involvement. The clinical presentation of myopericarditis is often with varying degrees of cardiac symptomatology. Its etiology is often idiopathic, but it may also be related to infectious and inflammatory prodrome. Symptoms are proportional to the extent and pattern of myocardial involvement. Many are diagnosed sub-clinically during the management of other systemic illnesses. Echocardiography and cardiac magnetic resonance imaging are important tools in the evaluation of myopericarditis, as the diagnosis of left ventricular dysfunction greatly affects the management, follow-up, and prognosis of these patients. The acute management of myopericarditis remains without clear direction and focuses on symptom control. The use of NSAIDs is often cautioned, as it has been described to actually accelerate the myocarditic process in animal models, possibly increasing mortality. Colchicine, a well-established anti-inflammatory agent, may have a role in the management of acute myopericarditis. We present two cases, each involving a young male, without underlying medical conditions, who presented to the emergency room with acute onset chest pain. Both were found to have elevated cardiac biomarkers and electrocardiographic (EKG) changes, admitted as in-patients and eventually diagnosed with acute myopericarditis. They made full recoveries and were eventually discharged home. Both were started on colchicine during hospitalization, which were continued for several months upon discharge. Overall, there is limited published data regarding the medical management of myopericarditis. There need to be prospective studies and registries to further our knowledge in the management of this illness.
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Affiliation(s)
- Rana Al-Zakhari
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Gautham Upadhya
- Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Sean Galligan
- Cardiology, Richmond University Medical Center, Staten Island, USA
| | - Fiona Shehaj
- Cardiology, Richmond University Medical Center, Staten Island, USA
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191
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Alcocer-Ayuga M, Madaria Z, Masia MD, Nuñez G, Gómez EH, Pinedo M, Diez I, Diaz-Gonzalez L, Maceira A, Boraita A. The Grey Zone and the Complexity of Clinical Decisions in Sports Cardiology. J Cardiovasc Transl Res 2020; 13:339-344. [PMID: 32562212 DOI: 10.1007/s12265-020-10046-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022]
Abstract
We present here three different clinical scenarios that illustrate the complexity of taking decisions in sports cardiology. Despite the availability of consensus documents, in clinical practice, decision-making process is most of the times in the grey zone.
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Affiliation(s)
- María Alcocer-Ayuga
- Department of Cardiology, Sports Medicine Center, Spanish Sports Health Protection Agency, Consejo Superior de Deportes, Madrid, Spain. .,Agencia Española para la Protección de la Salud en el Deporte, Unidad de Cardiología, C/ Pintor El Greco s/n, 28040, Madrid, Spain.
| | - Zigor Madaria
- H. Urduliz. Cardiology, Goieta Kalea, 32, 48610, Urduliz, Bizkaia, Spain.
| | - Mari Dolores Masia
- Hospital IMED Levante/Elche, Alicante, Spain. .,Servicio Cardiología deportiva IMED Levante, C/Dr. Santiago Ramón y Cajal, 7, 03503, Benidorm, Spain.
| | - Gaizka Nuñez
- H. Urduliz. Cardiology, Goieta Kalea, 32, 48610, Urduliz, Bizkaia, Spain
| | - Eugenia Heras Gómez
- Department of Cardiology, Sports Medicine Center, Spanish Sports Health Protection Agency, Consejo Superior de Deportes, Madrid, Spain.,Agencia Española para la Protección de la Salud en el Deporte, Unidad de Cardiología, C/ Pintor El Greco s/n, 28040, Madrid, Spain
| | - Marta Pinedo
- H. Urduliz. Cardiology, Goieta Kalea, 32, 48610, Urduliz, Bizkaia, Spain
| | - Ignacio Diez
- H. Urduliz. Cardiology, Goieta Kalea, 32, 48610, Urduliz, Bizkaia, Spain
| | | | - Alicia Maceira
- Cardiovascular Imaging Unit, ERESA Medical Center, Valencia, Spain
| | - Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Spanish Sports Health Protection Agency, Consejo Superior de Deportes, Madrid, Spain.,Agencia Española para la Protección de la Salud en el Deporte, Unidad de Cardiología, C/ Pintor El Greco s/n, 28040, Madrid, Spain
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192
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Cavigli L, Olivotto I, Fattirolli F, Mochi N, Favilli S, Mondillo S, Bonifazi M, D'Ascenzi F. Prescribing, dosing and titrating exercise in patients with hypertrophic cardiomyopathy for prevention of comorbidities: Ready for prime time. Eur J Prev Cardiol 2020; 28:1093-1099. [PMID: 33611579 DOI: 10.1177/2047487320928654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/02/2020] [Indexed: 01/09/2023]
Abstract
The benefits of physical activity are well established, leading to both cardiovascular and non-cardiovascular benefits, improving quality of life and reducing mortality. Despite such striking body of evidence, patients with hypertrophic cardiomyopathy are often discouraged by health professionals to practice physical activity and personalised exercise prescription is an exception rather than the rule. As a result, hypertrophic cardiomyopathy patients are on average less active and spend significantly less time at work or recreational physical activity than the general population. Exercise restriction derives from the evidence that vigorous exercise may occasionally trigger life-threatening arrhythmias and sudden cardiac death. However, while participation in competitive sports should be prudentially denied, hypertrophic cardiomyopathy patients can benefit from the positive effects of regular physical activity, aimed to reduce the risk of comorbidities and improve the quality of life. Based on this rationale, exercise should be prescribed and titrated just like a drug in hypertrophic cardiomyopathy patients, considering individual characteristics, symptoms, past medical history, objective individual response to exercise, previous training experience and stage of disease. Type, frequency, duration, and intensity should be defined on a personal basis. Yet exercise prescription in hypertrophic cardiomyopathy and its long-term effects represent major gaps in our current knowledge and require extensive research. We here review existing evidence regarding benefits and hazards of physical activity, with specific focus on viable modalities for tailored and safe exercise prescription in these patients, highlighting future developments and relevant research targets.
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Affiliation(s)
- Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Italy
| | | | | | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.,Department of Medicine, University of Pittsburgh, USA
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193
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Affiliation(s)
- Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Centre for Cardiac Arrhythmias of Genetic Origin, Italy
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194
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Hansson E, Glaser J, Jakobsson K, Weiss I, Wesseling C, Lucas RAI, Wei JLK, Ekström U, Wijkström J, Bodin T, Johnson RJ, Wegman DH. Pathophysiological Mechanisms by which Heat Stress Potentially Induces Kidney Inflammation and Chronic Kidney Disease in Sugarcane Workers. Nutrients 2020; 12:E1639. [PMID: 32498242 PMCID: PMC7352879 DOI: 10.3390/nu12061639] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. METHODS Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. RESULTS Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. DISCUSSION Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.
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Affiliation(s)
- Erik Hansson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Jason Glaser
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, 405 30 Gothenburg, Sweden
| | - Ilana Weiss
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Catarina Wesseling
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Rebekah A. I. Lucas
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, 142 Edgbaston Park Rd, Birmingham B15 2TT, UK
| | - Jason Lee Kai Wei
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 2 Medical Drive, MD9, National University of Singapore, Singapore 117593, Singapore;
- Global Asia Institute, National University of Singapore, 10 Lower Kent Ridge Rd, Singapore 119076, Singapore
- N.1 Institute for Health, National University of Singapore, 28 Medical Dr, Singapore 117456, Singapore
| | - Ulf Ekström
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, 221 85 Lund, Sweden
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science Intervention and Technology, Karolinska Institutet, 141 86 Stockholm, Sweden;
| | - Theo Bodin
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA;
| | - David H. Wegman
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA 01845, USA
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195
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Carvalho TD, Milani M, Ferraz AS, Silveira ADD, Herdy AH, Hossri CAC, Silva CGSE, Araújo CGSD, Rocco EA, Teixeira JAC, Dourado LOC, Matos LDNJD, Emed LGM, Ritt LEF, Silva MGD, Santos MAD, Silva MMFD, Freitas OGAD, Nascimento PMC, Stein R, Meneghelo RS, Serra SM. Brazilian Cardiovascular Rehabilitation Guideline - 2020. Arq Bras Cardiol 2020; 114:943-987. [PMID: 32491079 PMCID: PMC8387006 DOI: 10.36660/abc.20200407] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Universidade do Estado de Santa Catarina (Udesc), Florianópolis , SC - Brasil
| | | | | | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Instituto de Cardiologia de Santa Catarina , Florianópolis , SC - Brasil
- Unisul: Universidade do Sul de Santa Catarina (UNISUL), Florianópolis , SC - Brasil
| | | | | | | | | | | | - Luciana Oliveira Cascaes Dourado
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Rio de Janeiro , RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar , Salvador , BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública , Salvador , BA - Brasil
| | | | - Mauro Augusto Dos Santos
- ACE Cardiologia do Exercício , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | | | | | - Pablo Marino Corrêa Nascimento
- Universidade Federal Fluminense (UFF), Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Romeu Sergio Meneghelo
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro , RJ - Brasil
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196
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Moulson N, Dorian P, Krahn A, Virani A, Isserow S, McKinney J. Shared Decision Making and the Cardiovascular Care of Athletes: Is It Time to Get Back in the Game? Can J Cardiol 2020; 36:941-944. [DOI: 10.1016/j.cjca.2019.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 11/26/2022] Open
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197
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Crescenzi C, Panattoni G, Stazi A, Martino A, Sgueglia M, De Ruvo E, Calò L. Ventricular arrhythmias and risk stratification of cardiac sudden death in athletes. Minerva Cardioangiol 2020; 68:110-122. [PMID: 32429629 DOI: 10.23736/s0026-4725.20.05178-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) of young athletes is an unexpected and tragic event that could occur during sport activities and is frequently related to ventricular arrhythmias. Identifying athletes at risk of SCD remains a major challenge. While specific characteristics of premature ventricular contractions are considered common and benign, other "uncommon" features should require more accurate investigations, in order to determine eligibility for competitive sports. The most common type of idiopathic premature ventricular contractions originates from ventricular outflow tract and is characterized by an ECG pattern with left bundle branch block and inferior QRS axis (infundibular pattern). Another pattern associated with a good prognosis is the "fascicular" morphology, characterized by a typical right bundle branch block, superior QRS axis morphology and QRS duration <130 ms. Conversely, other morphological features (such as left bundle branch block /intermediate or superior axis or right bundle branch block/intermediate or superior axis and wide QRS) correlate to an underlying substrate. In risk stratification setting, cardiac magnetic resonance plays a key role allowing an accurate identification of myocardial tissue abnormalities, which could affect athletes' prognosis. This review focuses on characteristics of premature ventricular contractions characteristics in terms of morphology, distribution, complexity and response to exercise and describes the possible underlying myocardial substrates. This review also critically analyzes the evaluation process of athletes with premature ventricular contractions necessary for an accurate risk stratification.
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Affiliation(s)
| | | | | | | | | | | | - Leonardo Calò
- Division of Cardiology, Casilino Polyclinic, Rome, Italy -
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198
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Luo H, Galvão DA, Newton RU, Fairman CM, Taaffe DR. Sport Medicine in the Prevention and Management of Cancer. Integr Cancer Ther 2020; 18:1534735419894063. [PMID: 31838880 PMCID: PMC6913064 DOI: 10.1177/1534735419894063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Physical inactivity is a major concern in cancer patients despite the established preventative and therapeutic effects of regular physical exercise for this patient group. Sport not only plays an important role in supporting the development and maintenance of a physically active lifestyle but also is increasingly used as a health promotion activity in various populations. Nevertheless, the potential of sport as an effective strategy in the prevention and management of cancer has gained little attention. Based on the scant evidence to date, participation of cancer patients in supervised, well-tailored sport programs appears to be safe and feasible and is associated with an array of physical and psychological benefits. We propose that sport participation may serve as an alternative strategy in the prevention of cancer and sport medicine in the management of cancer. As with the traditional exercise modes, benefits derived from sport participation will be dependent on the sport undertaken and the physical/physiological, motor, and cognitive demands required. To this end, further work is required to develop a solid evidence base in this field so that targeted sport participation can be recommended for cancer patients.
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Affiliation(s)
- Hao Luo
- Guangdong Vocational Institute of Sport, Guangzhou, Guangdong, China.,Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland, Brisbane, Queensland, Australia.,The University of Hong Kong, Hong Kong
| | | | - Dennis R Taaffe
- Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland, Brisbane, Queensland, Australia
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199
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Liao YW, Redfern J, Somauroo JD, Cooper RM. Hypertrophic cardiomyopathy and exercise restrictions: time to let the shackles off? THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:11. [PMID: 35747091 PMCID: PMC8793933 DOI: 10.5837/bjc.2020.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The health benefits of physical activity are well documented. Patients with hypertrophic cardiomyopathy (HCM) are often discouraged from participating in physical activity due to a perceived increase in the risk of sudden cardiac death (SCD). As a result, only 45% of patients with HCM meet the minimum guidelines for physical activity, and many report an intentional reduction in exercise following diagnosis. Despite most SCD being unrelated to HCM, guidelines traditionally focused on the avoidance of potential risk through restriction of exercise, without clear recommendations on how to negate the negative health impact of inactivity. Retrospective reviews have demonstrated that the majority of cardiac arrests in patients with HCM occurred at rest or on mild exertion and that the overall incidence of HCM-related SCD is significantly lower than previously reported. We will discuss current international guidelines and recommendations and consider the outcomes of various studies that have investigated the effects of exercise of different intensities on patients with HCM. In light of the growing evidence suggesting that carefully guided exercise can be both beneficial and safe in patients with HCM, we ask whether it is time to let the shackles off exercise restriction in HCM.
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Affiliation(s)
- Yuen W Liao
- Foundation Year 2 Doctor Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE
| | - James Redfern
- Cardiology Specialty Registrar Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE
| | - John D Somauroo
- Consultant Cardiologist Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE
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200
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Pieles GE, Oberhoffer R. The Assessment of the Paediatric Athlete. J Cardiovasc Transl Res 2020; 13:306-312. [PMID: 32367344 PMCID: PMC7360531 DOI: 10.1007/s12265-020-10005-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/15/2020] [Indexed: 12/27/2022]
Abstract
The success of systematic early age talent development has led to the professionalisation of youth sports academies used by clubs and governing bodies alike, and sports physicians are nowadays commonly confronted with paediatric cardiological problems. Medical cardiac care of the paediatric athlete is however in its infancy, and the international guidelines that are present for adult athletes, are not yet available. Similarly, reference data for ECG and echocardiography are incomplete. The aim of this article is to provide and introduction to the cardiac care of the paediatric athlete to facilitate healthy and above all, safe talent development, but also provide guidance on how to distinguish adaptive, beneficial cardiovascular remodelling from underlying pathology of congenital or inherited cardiovascular disease. Differences in presentation, diagnosis and treatment between childhood and adult athletes are highlighted and can educate the reader in the emerging field of paediatric sports cardiology.
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Affiliation(s)
- Guido E Pieles
- Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
| | - Renate Oberhoffer
- Department of Sports and Health Sciences, Technical University Munich, Georg Brauchle Ring, 80992, Munich, Germany
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