Athlete’s Heart: Diagnostic Challenges and Future Perspectives

Innocentiis, Carlo De; Ricci, Fabrizio; Khanji, Mohammed Y; Aung, Nay; Tana, Claudio; Verrengia, Elvira; Petersen, Steffen E.; Gallina, Sabina

doi:10.1007/s40279-018-0985-2

Cited by 35 publications

(39 citation statements)

References 94 publications

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“…A challenging paper demonstrated that exercise testing could unmask depolarization and repolarization abnormalities as well as ventricular arrhythmia in mutation carriers, irrespective of the fulfillment of Task Force criteria and the symptomatic state, suggesting a potential use of this test to prescribe exercise in case it could be validated in that scenario (15). Against this hypothesis, another interesting work compared the arrhythmogenicity response during the isoproterenol and (11,12).…”

Section: Introductionmentioning

confidence: 99%

Facts and Gaps in Exercise Influence on Arrhythmogenic Cardiomyopathy: New Insights From a Meta-Analysis Approach

Martínez-Solé

Sabater-Molina

Braza-Boïls

et al. 2021

Front. Cardiovasc. Med.

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Arrhythmogenic cardiomyopathy (ACM) is a genetic cardiac condition characterized by fibrofatty myocardial replacement, either at the right ventricle, at the left ventricle, or with biventricular involvement. Ventricular arrhythmias and heart failure represent its main clinical features. Exercise benefits on mental and physical health are worldwide recognized. However, patients with ACM appear to be an exception. A thorough review of the literature was performed in PubMed searching for original papers with the terms “ARVC AND sports/exercise” and “sudden cardiac death AND sports/exercise.” Additional papers were then identified through other sources and incorporated to the list. All of them had to be based on animal models or clinical series. Information was structured in a regular format, although some data were not available in some papers. A total of 34 papers were selected and processed regarding sports-related sudden cardiac death, pre-clinical models of ACM and sport, and clinical series of ACM patients engaged in sports activities. Eligible papers were identified to obtain pooled data in order to build representative figures showing the global incidence of the most important causes of sudden cardiac death in sports and the global estimates of life-threatening arrhythmic events in ACM patients engaged in sports. Tables and figures illustrate their major characteristics. The scarce points of controversy were discussed in the text. Fundamental concepts were summarized in three main issues: sports may accelerate ACM phenotype with either structural and/or arrhythmic features, restriction may soften the progression, and these rules also apply to phenotype-negative mutation carriers. Additionally, remaining gaps in the current knowledge were also highlighted, namely, the applicability of those fundamental concepts to non-classical ACM phenotypes since left dominant ACM or non-plakophillin-2 genotypes were absent or very poorly represented in the available studies. Hopefully, future research endeavors will provide solid evidence about the safest exercise dose for each patient from a personalized medicine perspective, taking into account a big batch of genetic, epigenetic, and epidemiological variables, for instance, in order to assist clinicians to provide a final tailored recommendation.

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Section: Introductionmentioning

confidence: 99%

Facts and Gaps in Exercise Influence on Arrhythmogenic Cardiomyopathy: New Insights From a Meta-Analysis Approach

Martínez-Solé

Sabater-Molina

Braza-Boïls

et al. 2021

Front. Cardiovasc. Med.

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“…According to a review by De In-nocentiis et al, abnormal ECG findings are commonly observed in competitive athletes (nearly 15%), and are more frequently seen among Endurance athletes than Strength (Power) athletes. [ 11 ] Similarly, this study showed that abnormal ECG findings, including early repolarization, increased QRS voltage and sinus bradyarrhythmias, were common among Endurance athletes. This seems to be related to the higher cardiac output acquired during endurance exercise resulting in remodeling: increase cardiac dimensions and thickness.…”

Section: Discussionmentioning

confidence: 66%

Sport disciplines and cardiac remodeling in elite university athletes competing in 2017 Taipei Summer Universiade

Adea

Leonor

et al. 2020

Medicine

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Cardiac remodeling is common in the athletes. Little data is available regarding the cardiac remodeling on the recently proposed 4 sport disciplines among the elite university athletes. A total of 7639 athletes participated in the 2017 Taipei Summer Universiade. Cardiac evaluation via history, ECG, and echocardiography were performed in 826 athletes who signed up for Check Up Your Heart. Athletes were grouped into one of 4 sport disciplines Skill, Power, Mixed, and Endurance. After excluding 66 participants with missing demographic data, 13 missing echocardiographic data, and 24 inadequate echocardiographic images, a total number of 723 university athletes (mean age 23 ± 3 years, 419 males) from 99 countries engaging in 25 different sporting events were analyzed. Electrocardiograms showed that Endurance group had a slower heart rate and higher percentage of left ventricular (LV) hypertrophy (39%). Echocardiograms showed there were significant differences in LV mass index ( P < .001), LV geometry ( P < .001), left atrial (LA) dilatation ( P = .026), right ventricular (RV) dilatation ( P < .001), right atrial (RA) dilatation ( P < .0001), and tricuspid annular plane systolic excurse ( P = .006). LV ejection fraction, LV strain, RV strain, and LV diastolic function showed no difference in 4 sport disciplines. Eccentric LV hypertrophy was the most common type of cardiac remodeling in the university athletes participated in 2017 Taipei Summer Universiade. Adaptive changes in chamber size were more commonly seen in Endurance sport. RA dilatation was the most sensitive to hemodynamic demand, followed by RV dilatation, LA dilatation, and LV dilatation.

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“…As reported by De Innocentiis et al. in a recent review, 12 several diagnostic tools (resting ECG, echocardiography, cardiovascular magnetic resonance) and methods (two and three-dimensional measurements, myocardial strain imaging, etc.) involved in the pre-participation examination of athletes allow the comprehensive morphological and functional evaluation of the heart and distinction between physiological and pathological adaptation.…”

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confidence: 88%