1
|
Shibbani K, Abdulkarim A, Budts W, Roos-Hesselink J, Müller J, Shafer K, Porayette P, Zaidi A, Kreutzer J, Alsaied T. Participation in Competitive Sports by Patients With Congenital Heart Disease: AHA/ACC and EAPC/ESC/AEPC Guidelines Comparison. J Am Coll Cardiol 2024; 83:772-782. [PMID: 38355248 DOI: 10.1016/j.jacc.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/27/2023] [Accepted: 10/20/2023] [Indexed: 02/16/2024]
Abstract
Sports participation in patients with congenital heart disease is an evolving subject. The American Heart Association/American College of Cardiology released a set of guidelines that advise the type and level of sports participation based primarily on anatomical defects with secondary consideration given to hemodynamic effects. Recently, the European Association of Preventive Cardiology/European Society of Cardiology/Association for European Paediatric and Congenital Cardiology offered a contrasting approach to sports participation that is based on hemodynamic and electrophysiological profiles of each patient, regardless of anatomical consideration. These guidelines are drastically different in their approaches but do have some similarities. In this review, we compare both documents, focusing on the aim, population, classification of sports, and the methodology of making recommendations. This review aims to assist practicing cardiologists in integrating the available published data and recommendations when counseling patients for sports participation.
Collapse
Affiliation(s)
- Kamel Shibbani
- Division of Cardiology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA; University of California-San Diego, Rady Children's Hospital, Department of Pediatrics, San Diego, California, USA.
| | - Ali Abdulkarim
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals, and Department of Cardiovascular Sciences, Catholic University, Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands; ERN-GUARD HEART (European Reference Network)
| | - Jan Müller
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
| | - Keri Shafer
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Prashob Porayette
- Division of Cardiology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Ali Zaidi
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacqueline Kreutzer
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tarek Alsaied
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
Pelliccia A, Day S, Olivotto I. Leisure-time and competitive sport participation: a changing paradigm for HCM patients. Eur J Prev Cardiol 2023; 30:zwad011. [PMID: 36638119 DOI: 10.1093/eurjpc/zwad011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
HCM has long been considered the most frequent cause of death in athletes, and reason for disqualification from sport. However, our perception of the impact of sports on HCM is largely based on anecdotal evidence. In this review, we provide a reappraisal of current knowledge relative to 1) the impact of sport on LV remodeling, and 2) on the clinical outcome of HCM in athletes. 1) The limited available evidence argues against the hypothesis that intensive exercise conditioning may trigger and/or worsen the development of LV hypertrophy or cause changes in LV function in adult HCM athletes. 2) Recent observations challenge the concept of a detrimental effect of sport on HCM clinical course. The Reset-HCM study showed that 16-week moderate-intensity exercise resulted in a small, significant increase in exercise capacity and no adverse events. In a cohort of 88 low-risk HCM athletes followed for a 7-year period, survival analyses showed no difference in mortality between HCM who discontinued or pursued vigorous exercise programmes. Further reassurance was provided by the ICD Sports Safety Registry. Clinical implications: At present, patients' attitude to sport participation is highly variable, based on social and legal backgrounds surrounding medical practice in different countries. The shared-decision-making as suggested by current US and European guidelines allows the physician to deliver a tailored and more liberal advice. Physicians should be aware of the changing paradigm relative to exercise and sport prescription for HCM and promote active lifestyle as an integral component of modern management of HCM patients.
Collapse
Affiliation(s)
| | - Sharlene Day
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
3
|
COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art. Turk J Phys Med Rehabil 2022; 68:317-335. [DOI: 10.5606/tftrd.2022.11435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient’s prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is “a state of complete physical, mental and social well-being”, individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.
Collapse
|
4
|
The Impact of Physical Activity on Pericarditis. Curr Cardiol Rep 2021; 23:150. [PMID: 34448954 PMCID: PMC8390544 DOI: 10.1007/s11886-021-01578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/02/2022]
Abstract
Purpose of Review To discuss the possible harmful effects and pathophysiology of exercise in cases of pericarditis, explore the role of multi-modality imaging to help guide exercise recommendations, and compare U.S. with European guideline recommendations on the safe resumption of physical activity following resolution of pericarditis. Recent Findings Despite multiple postulated mechanisms by which exercise may be harmful during active inflammation of the myocardium or pericardium, the exact pathophysiology remains largely unknown. The inclusion of multi-modality cardiac imaging may play a role in further elucidating the relationship of exercise with outcomes in pericarditis. More recently, the prevalence of COVID-19 cardiac involvement in athletes prior to returning to play appears lower than previously reported; however, current recommendations are consistent with those for other etiologies of pericarditis. Summary Further research is certainly needed to better understand the relationship between physical activity and pericarditis, the pathophysiology, and the prognostic role of multimodality imaging.
Collapse
|
5
|
Ilodibia TF, Odia JO. Evaluation of the Seattle and International Criteria in elite Nigerian athletes. J Electrocardiol 2021; 68:14-23. [PMID: 34273803 DOI: 10.1016/j.jelectrocard.2021.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Seattle Criteria (SC) and International Criteria (IC) were both developed for cardiovascular pre-participation screening in young athletes. Neither set of Criteria has been systematically evaluated in high level indigenous black African athletes. OBJECTIVES (1) To determine the pattern of ECG findings in athletes of the University of Port Harcourt, Nigeria; (2) To determine the predictors of altered repolarization in these athletes; and (3) To evaluate the diagnostic performance of the SC and IC in these athletes. METHODS 77 athletes (42 males, 35 females) without any known cardiovascular disease were recruited alongside 78 similarly healthy non-athletic controls (44 males, 34 females). The two groups were matched for age, sex, and body mass index. Clinical assessment was according to the Lausanne Recommendations. All subjects underwent electrocardiography and echocardiography. Analysis with the IC was retrospective. RESULTS The most common physiological finding in the athletes was sinus bradycardia (n = 37; 48.1%). Early repolarization pattern, ERP (n = 27, 35.1% with SC; n = 42, 54.5% with IC), and dome-shaped ST-segment elevation with T-wave inversion (DSSTWI) in leads V1-4 (n = 21, 29.3% with both criteria), were also prevalent. Compared to controls, only male sex (adjusted odds ratio 2.89, 1.05 to 7.97, p = .040 with SC; OR 2.57, 1.19 to 5.53, p = .016 with IC) and ECG LVH (OR 2.82, 1.18 to 6.75, p = .020 with SC alone) independently predicted ERP, while athletic status (OR 4.76, 1.66 to 13.68, p = .004 with both criteria) alone had a significant multivariate association with DSSTWI. Three athletes (3.9%) had abnormal ECGs while two (2.6%) had major echocardiographic abnormalities. The sensitivity, specificity and accuracy of the SC for structural cardiac disease in the athletes were 50.0% (1.3 to 98.7), 97.3% (90.7 to 99.7) and 96.1% (89.0 to 99.2) respectively. The respective figures for the IC were 50.0% (1.3 to 98.7), 98.7% (92.8 to 100) and 97.4% (90.9 to 99.7). CONCLUSION Both criteria showed high accuracy in this Black African cohort with a high frequency of electrocardiographic repolarization changes. While ERP seems to be primarily related to black ethnicity, DSSTWI appears to be a bona fide marker of Athlete's Heart in blacks.
Collapse
Affiliation(s)
- Tochukwu F Ilodibia
- Division of Cardiology, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, East-West Road, Opposite Alakahia Junction, Rivers State, PMB, 6173, Nigeria.
| | - James O Odia
- Division of Cardiology, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, East-West Road, Opposite Alakahia Junction, Rivers State, PMB, 6173, Nigeria
| |
Collapse
|
6
|
Chin TJ, Lee ACL, Fulcher ML. Professional footballers have a limited understanding of the precompetition medical assessment and the possible outcomes including disqualification: a cross-sectional survey. BMJ Open Sport Exerc Med 2021; 7:e001006. [PMID: 33768962 PMCID: PMC7944969 DOI: 10.1136/bmjsem-2020-001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives To determine professional footballers’ level of understanding of the purpose of the precompetition medical assessment (PCMA) and to evaluate their knowledge of potential outcomes following a PCMA, including disqualification. Methods Professional footballers from the Australasian A-League and Westfield W-League were asked to complete a 25-question survey. The relationship between dichotomised outcomes and explanatory variables was analysed with multivariate logistic regression; p<0.05 was considered statistically significant. Results A total of 212 players participated (response rate=48.8%). Most respondents selected ‘To detect medical conditions that may affect performance’ and ‘To detect current injuries’ (n=137, 64.6%; n=130, 61.3%) as the purpose of a PCMA. Approximately one-third (n=74, 38.1%) were neutral or believed that a normal PCMA prevented cardiac arrest. Receiving more PCMAs (p<0.0003) and receiving an explanation during their PCMA (p=0.0175) led to greater awareness of the assessment’s limitations. Most participants did not know the definitions of syncope (n=181, 93.3%) or Marfan syndrome (n=183, 94.3%). Fifty players (28.1%) did not know that disqualification was a possible outcome of a PCMA, and younger players were less aware of this possible outcome (p=0.0216). Conclusion Professional footballers appear to have a limited understanding of the purpose of a PCMA, emphasising the musculoskeletal system and performance. They also appear unfamiliar with the components of the PCMA and medical terms. Finally, many are unaware that disqualification can result from an abnormal PCMA. Player health knowledge must be improved; the informed consent process appears an ideal time to provide this education.
Collapse
Affiliation(s)
- Thomas J Chin
- Anglesea Sports Medicine, Hamilton, New Zealand.,Summit Sports Medicine, Mount Maunganui, New Zealand
| | - Arier C L Lee
- Department of Epidemiology and Biostatistics, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Mark L Fulcher
- Axis Sports Medicine Specialists, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| |
Collapse
|
7
|
Magavern EF, Finocchiaro G, Sharma S, Papadakis M, Borry P. Time out: ethical reflections on medical disqualification of athletes in the context of mandated pre-participation cardiac screening. Br J Sports Med 2017; 52:1207-1210. [DOI: 10.1136/bjsports-2017-097524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 01/02/2023]
|
8
|
Baggish AL, Battle RW, Beckerman JG, Bove AA, Lampert RJ, Levine BD, Link MS, Martinez MW, Molossi SM, Salerno J, Wasfy MM, Weiner RB, Emery MS. Sports Cardiology. J Am Coll Cardiol 2017; 70:1902-1918. [DOI: 10.1016/j.jacc.2017.08.055] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/27/2017] [Indexed: 01/02/2023]
|
9
|
Abstract
Improved public awareness and advances in medical diagnostics have resulted in the development of criteria to determine eligibility or disqualification for the athlete with cardiovascular abnormalities. Simultaneously, protocols have been developed for athletes with concussion or orthopaedic injuries to guide team physicians and consultants in return-to-play decisions. However, there are currently inadequate data to allow the development of such protocols for athletes with cardiovascular abnormalities who have undergone treatment. Further complicating the decision process is the designation of the team physician as the ultimate authority in making return-to-play decisions - where the team physician often is an employee of the team and supports the team's goal and players as well as the individual athlete. This review will discuss the ethical dilemma of the team physician and the role of the cardiovascular consultant. Following this, current data and practices regarding return to play will be discussed for the following conditions or diagnoses: following catheter ablation for supraventricular tachycardia; following pacemaker or implantable cardioverter-defibrillator implantation; unexplained syncope; and the athlete with a genetic mutation in the absence of any phenotype of associated disease. These recommendations will undoubtedly continue to evolve and improve and should be considered at this time as a point of departure.
Collapse
|
10
|
Medico-legal perspectives on sudden cardiac death in young athletes. Int J Legal Med 2016; 131:393-409. [PMID: 27654714 DOI: 10.1007/s00414-016-1452-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/08/2016] [Indexed: 01/11/2023]
|