Medicine › Cardiology and Cardiovascular Medicine

Cardiovascular Effects of Exercise

Works Count: 43382

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This cluster of papers focuses on the diagnosis, management, and genetic aspects of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in athletes and young adults. It explores the role of exercise in triggering sudden cardiac death, recommendations for preparticipation screening, interpretation of electrocardiograms in athletes, and the use of implantable cardioverter-defibrillator therapy. Additionally, it discusses the impact of exercise on cardiac remodeling, the association with atrial fibrillation, and the genetic mutations associated with ARVC.

Keywords

Arrhythmogenic Right Ventricular Cardiomyopathy; Sudden Death; Athletes; Cardiac Screening; Genetic Mutations; Electrocardiogram Interpretation; Exercise-Induced Dysfunction; Implantable Cardioverter-Defibrillator Therapy; Cardiac Remodeling; Atrial Fibrillation

Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies

1996-03-01

Peter Richardson , William J. McKenna , Michael R. Bristow +7 more

Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion

1993-12-02

Murray A. Mittleman , Malcolm Maclure , Geoffrey H. Tofler +3 more

Despite anecdotal evidence suggesting that heavy physical exertion can trigger the onset of acute myocardial infarction, there have been no controlled studies of the risk of myocardial infarction during and … Despite anecdotal evidence suggesting that heavy physical exertion can trigger the onset of acute myocardial infarction, there have been no controlled studies of the risk of myocardial infarction during and after heavy exertion, the length of time between heavy exertion and the onset of symptoms (induction time), and whether the risk can be modified by regular physical exertion. To address these questions, we collected data from patients with confirmed myocardial infarction on their activities one hour before the onset of myocardial infarction and during control periods.

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Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: Proposed Modification of the Task Force Criteria

2010-02-19

Gregory M. Marcus , William J. McKenna , D. Sherrill +7 more

In 1994, an International Task Force proposed criteria for the clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) that facilitated recognition and interpretation of the frequently nonspecific clinical features of … In 1994, an International Task Force proposed criteria for the clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) that facilitated recognition and interpretation of the frequently nonspecific clinical features of ARVC/D. This enabled confirmatory clinical diagnosis in index cases through exclusion of phenocopies and provided a standard on which clinical research and genetic studies could be based. Structural, histological, electrocardiographic, arrhythmic, and familial features of the disease were incorporated into the criteria, subdivided into major and minor categories according to the specificity of their association with ARVC/D. At that time, clinical experience with ARVC/D was dominated by symptomatic index cases and sudden cardiac death victims–the overt or severe end of the disease spectrum. Consequently, the 1994 criteria were highly specific but lacked sensitivity for early and familial disease. Revision of the diagnostic criteria provides guidance on the role of emerging diagnostic modalities and advances in the genetics of ARVC/D. The criteria have been modified to incorporate new knowledge and technology to improve diagnostic sensitivity, but with the important requisite of maintaining diagnostic specificity. The approach of classifying structural, histological, electrocardiographic, arrhythmic, and genetic features of the disease as major and minor criteria has been maintained. In this modification of the Task Force criteria, quantitative criteria are proposed and abnormalities are defined on the basis of comparison with normal subject data. The present modifications of the Task Force Criteria represent a working framework to improve the diagnosis and management of this condition. clinicaltrials.gov Identifier: NCT00024505.

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The Degree of Masculine Differentiation of Obesities

1956-02-01

J Vague

Bundle-branch block with short P-R interval in healthy young people prone to paroxysmal tachycardia

1930-08-01

Louis Wolff , John Parkinson , Paul D. White

Spectrum of Clinicopathologic Manifestations of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Multicenter Study

1997-11-01

Domenico Corrado , Cristina Basso , Gaetano Thiene +7 more

Sudden death in young athletes.

1980-08-01

Barry J. Maron , William C. Roberts , Hugh A. McAllister +2 more

The causes of sudden and unexpected death in 29 highly conditioned, competitive athletes, ages 13-30 years, are summarized. Sudden death occurred during or just after severe exertion on the athletic … The causes of sudden and unexpected death in 29 highly conditioned, competitive athletes, ages 13-30 years, are summarized. Sudden death occurred during or just after severe exertion on the athletic field in 22 of the 29 athletes. Structural cardiovascular abnormalities were identified at necropsy in 28 of the 29 athletes (97%), and in 22 (76%) were almost certainly the cause of death. The most common cause of death in this series was hypertrophic cardiomyopathy, which was present in 14 athletes. Other cardiovascular abnormalities that occurred in more than one athlete were anomalous origin of the left coronary artery from the right (anterior) sinus of Valsalva, idiopathic concentric left ventricular hypertrophy, coronary heart disease and ruptured aorta. Cardiac disease was suspected during life in only seven of the 29 patients, and in only two of the seven was the correct diagnosis made clinically. Hence, in this series of young athletes, sudden death was usually due to structural cardiovascular disease, and hypertrophic cardiomyopathy was a frequent cause of sudden death; atherosclerotic coronary heart disease was relatively uncommon.

Trends in Sudden Cardiovascular Death in Young Competitive Athletes After Implementation of a Preparticipation Screening Program

2006-10-03

Domenico Corrado , Cristina Basso , Andrea Pavei +3 more

A nationwide systematic preparticipation athletic screening was introduced in Italy in 1982. The impact of such a program on prevention of sudden cardiovascular death in the athlete remains to be … A nationwide systematic preparticipation athletic screening was introduced in Italy in 1982. The impact of such a program on prevention of sudden cardiovascular death in the athlete remains to be determined.To analyze trends in incidence rates and cardiovascular causes of sudden death in young competitive athletes in relation to preparticipation screening.A population-based study of trends in sudden cardiovascular death in athletic and nonathletic populations aged 12 to 35 years in the Veneto region of Italy between 1979 and 2004. A parallel study examined trends in cardiovascular causes of disqualification from competitive sports in 42,386 athletes undergoing preparticipation screening at the Center for Sports Medicine in Padua (22,312 in the early screening period [1982-1992] and 20,074 in the late screening period [1993-2004]).Incidence trends of total cardiovascular and cause-specific sudden death in screened athletes and unscreened nonathletes of the same age range over a 26-year period.During the study period, 55 sudden cardiovascular deaths occurred in screened athletes (1.9 deaths/100,000 person-years) and 265 sudden deaths in unscreened nonathletes (0.79 deaths/100,000 person-years). The annual incidence of sudden cardiovascular death in athletes decreased by 89% (from 3.6/100,000 person-years in 1979-1980 to 0.4/100,000 person-years in 2003-2004; P for trend < .001), whereas the incidence of sudden death among the unscreened nonathletic population did not change significantly. The mortality decline started after mandatory screening was implemented and persisted to the late screening period. Compared with the prescreening period (1979-1981), the relative risk of sudden cardiovascular death in athletes was 0.56 in the early screening period (95% CI, 0.29-1.15; P = .04) and 0.21 in the late screening period (95% CI, 0.09-0.48; P = .001). Most of the reduced mortality was due to fewer cases of sudden death from cardiomyopathies (from 1.50/100,000 person-years in the prescreening period to 0.15/100,000 person-years in the late screening period; P for trend = .002). During the study period, 879 athletes (2.0%) were disqualified from competition due to cardiovascular causes at the Center for Sports Medicine: 455 (2.0%) in the early screening period and 424 (2.1%) in the late screening period. The proportion of athletes who were disqualified for cardiomyopathies increased from 20 (4.4%) of 455 in the early screening period to 40 (9.4%) of 424 in the late screening period (P = .005).The incidence of sudden cardiovascular death in young competitive athletes has substantially declined in the Veneto region of Italy since the introduction of a nationwide systematic screening. Mortality reduction was predominantly due to a lower incidence of sudden death from cardiomyopathies that paralleled the increasing identification of athletes with cardiomyopathies at preparticipation screening.

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Comparative Left Ventricular Dimensions in Trained Athletes

1975-04-01

Joel Morganroth

Little is known about the structure of athletes' hearts or anatomic variations associated with training. Echocardiograms of 56 active athletes were obtained. Mean left ventricular end-diastolic volume and mass were … Little is known about the structure of athletes' hearts or anatomic variations associated with training. Echocardiograms of 56 active athletes were obtained. Mean left ventricular end-diastolic volume and mass were increased in athletes involved in isotonic exercise, such as swimming (181 ml, 308 g) and running (160 ml, 302 g), compared with controls (101 ml, 211 g); wall thickness was normal (≤ 12 mm). Athletes involved in isometric exercise, such as wrestling and shot putting, had normal mean left ventricular end-diastolic volumes (110 ml, 122 ml), but increased wall thickness (13 to 14 mm) and mass (330 g, 348 g). Thus, athletes participating in isotonic exercise had increased left ventricular mass with cardiac changes similar to those in chronic volume overloads. Athletes participating in isometric exercise had increased left ventricular mass with cardiac changes similar to those in chronic pressure loads. Recognizing greater left ventricular mass and volume in well-trained athletes aids in interpreting values deviating from "normal" limits.

CORONARY DISEASE AMONG UNITED STATES SOLDIERS KILLED IN ACTION IN KOREA

1953-07-18

William F. Enos

The purpose of this paper is to describe and analyze the gross lesions found in the coronary arteries of United States soldiers killed in action in Korea. The histology will … The purpose of this paper is to describe and analyze the gross lesions found in the coronary arteries of United States soldiers killed in action in Korea. The histology will be discussed in detail in a subsequent paper as will such pertinent data as race, body build, and personal habits. <h3>MATERIAL</h3> Recently 300 autopsies were performed on United States battle casualties in Korea. Most of these soldiers were killed in action or suffered accidental death in front line areas. The coronary arteries were carefully dissected in all cases. No case in which there was known clinical evidence of coronary disease was included in this series. The average age in 200 cases was 22.1 years. The ages in the first 98 cases were not recorded except that the oldest patient was 33. In the entire series, the youngest recorded age was 18 and the oldest 48. <h3>FINDINGS</h3> In 77.3% of the

Mutations in the desmosomal protein plakophilin-2 are common in arrhythmogenic right ventricular cardiomyopathy

2004-10-17

Brenda Gerull , Arnd Heuser , Thomas Wichter +7 more

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Sudden Death in Young Competitive Athletes

1996-07-17

Barry J. Maron

To develop clinical, demographic, and pathological profiles of young competitive athletes who died suddenly.Systematic evaluation of clinical information and circumstances associated with sudden deaths; interviews with family members, witnesses, and … To develop clinical, demographic, and pathological profiles of young competitive athletes who died suddenly.Systematic evaluation of clinical information and circumstances associated with sudden deaths; interviews with family members, witnesses, and coaches; and analyses of postmortem anatomic, microscopic, and toxicologic data.A total of 158 sudden deaths that occurred in trained athletes throughout the United States from 1985 through 1995 were analyzed. MAIN OUTCOME MEASURES--Characteristics and probable cause of death.Of 158 sudden deaths among athletes, 24 (15%) were explained by noncardiovascular causes. Among the 134 athletes who had cardiovascular causes of sudden death, the median age was 17 years (range, 12-40 years), 120 (90%) were male, 70 (52%) were white, and 59 (44%) were black. The most common competitive sports involved were basketball (47 cases) and football (45 cases), together accounting for 68% of sudden deaths. A total of 121 athletes (90%) collapsed during or immediately after a training session (78 cases) or a formal athletic contest (43 cases), with 80 deaths (63%) occurring between 3 PM and 9 PM. The most common structural cardiovascular diseases identified at autopsy as the primary cause of death were hypertrophic cardiomyopathy (48 athletes [36%]), which was disproportionately prevalent in black athletes compared with white athletes (48% vs 26% of deaths; P = .01), and malformations involving anomalous coronary artery origin (17 athletes [13%]). Of 115 athletes who had a standard preparticipation medical evaluation, only 4 (3%) were suspected of having cardiovascular disease, and the cardiovascular abnormality responsible for sudden death was correctly identified in only 1 athlete (0.9%).Sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy. Preparticipation screening appeared to be of limited value in identification of underlying cardiovascular abnormalities.

Molecular distinction between physiological and pathological cardiac hypertrophy: Experimental findings and therapeutic strategies

2010-05-03

Bianca C. Bernardo , Kate L. Weeks , Lynette Pretorius +1 more

Screening for Hypertrophic Cardiomyopathy in Young Athletes

1998-08-06

Domenico Corrado , Cristina Basso , Maurizio Schiavon +1 more

For more than 20 years in Italy, young athletes have been screened before participating in competitive sports. We assessed whether this strategy results in the prevention of sudden death from … For more than 20 years in Italy, young athletes have been screened before participating in competitive sports. We assessed whether this strategy results in the prevention of sudden death from hypertrophic cardiomyopathy, a common cardiovascular cause of death in young athletes.

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Arrhythmogenic Right Ventricular Cardiomyopathy

1996-09-01

Cristina Basso , Gaetano Thiene , Domenico Corrado +3 more

Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a frequent cause of sudden death in young individuals and athletes. Although familial occurrence has been documented and a gene defect was recently … Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a frequent cause of sudden death in young individuals and athletes. Although familial occurrence has been documented and a gene defect was recently localized on chromosome 14q23-q24 the etiopathogenesis of the disease is still obscure. Methods and Results A pathological study was conducted in 30 hearts with ARVC (age range, 15 to 65 years; mean, 28 years). In the 27 autopsy cases, the mode of death was sudden in 24 and congestive heart failure in 3. ECG, available in 19 cases, showed inverted T waves in the right precordial leads in 15 cases (79%) and ventricular arrhythmias in 15 (79%). Right ventricular aneurysms were present in 15 hearts (50%) and located in the inferior wall in 12. Left ventricle and ventricular septum were involved in 14 (47%) and 6 (20%) cases, respectively. Scattered foci of lymphocytes with myocardial death were observed in 20 cases (67%). Electron microscopy studies, although confirming the myocardial death and lymphocyte infiltrates, did not show any specific ultrastructural substrate. Two pathological patterns, fatty (40%) and fibrofatty (60%), were identified. The fibrofatty pattern was associated with a thinner right ventricular wall ( P <.0001) and a higher occurrence of focal myocarditis ( P <.001). In sections of right ventricular free wall with maximal fatty infiltration, the mean percentage area of fatty tissue was 35.9±11.1% in control versus 80.4±9.6% in the ARVC, fatty variety ( P <.00001). Involvement of the left ventricle and/or ventricular septum, right ventricular aneurysms, and inflammation were found almost exclusively in the fibrofatty variety. Conclusions In the fibrofatty variety of ARVC, the myocardial atrophy appears to be the consequence of acquired injury (myocyte death) and repair (fibrofatty replacement), mediated by patchy myocarditis. Whether the inflammation is a primary event or a reaction to spontaneous cell death remains unclear.

Right Ventricular Cardiomyopathy and Sudden Death in Young People

1988-01-21

Gaetano Thiene , Andrea Nava , Domenico Corrado +2 more

From 1979 to 1986, we conducted postmortem studies of 60 persons under 35 years of age who had died suddenly in the Veneto Region of northeastern Italy. Unexpectedly, we found … From 1979 to 1986, we conducted postmortem studies of 60 persons under 35 years of age who had died suddenly in the Veneto Region of northeastern Italy. Unexpectedly, we found that 12 subjects — 7 males and 5 females ranging in age from 13 to 30 years — had morphologic features of right ventricular cardiomyopathy. This disorder had not been diagnosed or suspected before the subjects died. In five cases, sudden death was the first sign of disease; the remaining seven subjects had a history of palpitations, syncopal episodes, or both, and in five of those seven, ventricular arrhythmias had previously been recorded on electrocardiographic examination. Ten of the subjects had died during exertion. At autopsy, the subjects' heart weights were normal or moderately increased. Two main histologic patterns were identified — a lipomatous transformation or a fibrolipomatous transformation of the right ventricular free wall (6 cases each); in all cases, the left ventricle was substantially spared. Signs of myocardial degeneration and necrosis, with or without inflammatory infiltrates, were occasionally observed. These findings indicate that right ventricular cardiomyopathy, the cause of which is still unknown, may be more frequent than previously thought. At least in this area of Italy, it may represent an important cause of sudden death among young people. (N Engl J Med 1988; 318:129–33.)

ACSM’s New Preparticipation Health Screening Recommendations from ACSM’s Guidelines for Exercise Testing and Prescription, Ninth Edition

2013-01-01

Paul M. Thompson , Ross Arena , Deborah Riebe +1 more

Introduction Previously the American College of Sports Medicine (ACSM) preparticipation health screening recommendations were cardiovascular disease (CVD) risk assessment and stratification of all people, and a medical examination and symptom-limited … Introduction Previously the American College of Sports Medicine (ACSM) preparticipation health screening recommendations were cardiovascular disease (CVD) risk assessment and stratification of all people, and a medical examination and symptom-limited exercise testing as part of the preparticipation health screening prior to initiating vigorous-intensity physical activity in individuals at increased risk for occult CVD (14). Individuals at increased risk in these recommendations were men ≥45 yr and women ≥55 yr; those with 2 or more major CVD risk factors; individuals with signs and symptoms of CVD; and those with known cardiac, pulmonary, or metabolic disease. ACSM’s new preparticipation health screening recommendations are as follows: Reduce the emphasis on the need for medical evaluation (i.e., medical examination and exercise testing) as part of the preparticipation health screening process prior to initiating a progressive exercise regimen in healthy, asymptomatic persons; Use the term risk classification to group people as low, moderate, or high risk based upon the presence or absence of CVD risk factors, signs or symptoms, and/or known cardiovascular, pulmonary, renal, or metabolic disease; Emphasize identifying those with known disease since they are at greatest risk for an exercise-related cardiac event (Table); Adopt the American Association of Cardiovascular and Pulmonary Rehabilitation risk stratification scheme for people with known CVD because it considers over all patient prognosis and potential for rehabilitation (16); and Support the public health message that all people should adopt a physically active lifestyle. TABLE: New ACSM GETP9 recommendations for exercise testing in asymptomatic people prior to exercise for individuals at high risk (10).ACSM’s new preparticipation health screening recommendations continue to encourage atherosclerotic CVD risk factor assessment, since such measurements are an important part of the preparticipation health screening process and good medical care but do seek to simplify the preparticipation health screening process in order to remove unnecessary and unproven barriers to adopting a physically active lifestyle (11). There are multiple considerations that have prompted these different points of emphasis. The risk of a cardiovascular event is increased during vigorous-intensity exercise relative to rest, but the absolute risk of a cardiac event is low in healthy individuals. Recommending a medical examination and/or stress test as part of the preparticipation health screening process for all people at moderate to high risk prior to initiating light- to moderate-intensity exercise program implies that being physically active confers greater risk than a sedentary lifestyle (3). Yet the cardiovascular health benefits of regular exercise far outweigh the risks of exercise for the general population (12,13). There is also an increased appreciation that exercise testing is a poor predictor of acute CVD events such as heart attacks and sudden death in asymptomatic individuals probably because such testing detects flow-limiting coronary lesions, whereas sudden cardiac death and acute myocardial infarction are produced usually by the rapid progression of a previously nonobstructive lesion (13). Furthermore there is lack of consensus regarding the extent of the medical evaluation (i.e., medical examination and stress testing) needed as part of the preparticipation health screening process prior to initiating an exercise program even if it is of vigorous intensity (1,5,15). There is also evidence from decision analysis modeling that routine screening using exercise testing prior to initiating an exercise program is not warranted regardless of baseline individual risk (7). These considerations form the basis for the new ACSM preparticipation health screening recommendations that follows (10). Preparticipation Health Screening Recommendations All people wanting to initiate a physical activity program should be screened at minimum by a self-reported medical history or health risk appraisal questionnaire such as the PAR-Q (4) or modified American Heart Association/ACSM Health/Fitness Facility PreparticipationScreening Questionnaire (2) for the presence of risk factors for various cardiovascular, pulmonary, renal, and metabolic diseases as well as other conditions (e.g., pregnancy and orthopedic injury) that require special attention when developing the exercise prescription (Ex Rx) (6,8,9). Recommendations for a Medical Examination Prior to Initiating Physical Activity Individuals at moderate risk with two or more CVD risk factors (Figure) should be encouraged to consult with their physician prior to initiating a vigorous-intensity physical activity program. While medical evaluation is taking place, the majority of these people can begin without consulting a physician light- to moderate-intensity physical activity programs such as walking. Individuals at high risk with symptoms or diagnosed disease (Table) should consult with their physician prior to initiating a physical activity program (Figure). FIGURE: Medical examination, exercise testing, and exercise supervision recommendations based on risk classification. (Reprinted from Pescatello LS, Riebe D, Arena R. ACSM’s Guidelines for Exercise Testing and Prescription, 9th ed. Baltimore (MD): Lippincott Williams & Wilkins; 2013. Copyright © 2013 American College of Sports Medicine. Used with permission.)Recommendations for Exercise Testing Prior to Initiating Physical Activity Routine exercise testing before initiating a vigorous-intensity physical activity program is recommended only for individuals at high risk of exercise-related complications (Table and Figure). Exercise testing is warranted also whenever the health/fitness and clinical exercise professional has concerns about an individual’s CVD risk or requires additional information to design an Ex Rx, or when the exercise participant has concerns about starting an exercise program of any intensity without such testing. Recommendations for Supervision of Exercise Testing Exercise testing of individuals at high risk can be supervised by nonphysician health care professionals if the professional is specially trained in clinical exercise testing with a physician immediately available if needed. Exercise testing of individuals at moderate risk can be supervised by nonphysician health care professionals if the professional is trained specifically in clinical exercise testing, but whether or not a physician must be immediately available for exercise testing is dependent on local policies and circumstances, the health status of the patients, and the training and experience of the laboratory staff. In conclusion, the new ACSM preparticipation health screening recommendations are made to reduce barriers to the adoption of a physically active lifestyle because of the following: 1) Much of the risk associated with exercise can be mitigated by adopting a progressive exercise training regimen, and 2) there is an overall low risk of participation in physical activity programs (1). The authors declare no conflicts of interest and do not have any financial disclosures.

Sudden Deaths in Young Competitive Athletes

2009-02-17

Barry J. Maron , Joseph J. Doerer , Tammy S. Haas +2 more

Background— Sudden deaths in young competitive athletes are highly visible events with substantial impact on the physician and lay communities. However, the magnitude of this public health issue has become … Background— Sudden deaths in young competitive athletes are highly visible events with substantial impact on the physician and lay communities. However, the magnitude of this public health issue has become a source of controversy. Methods and Results— To estimate the absolute number of sudden deaths in US competitive athletes, we have assembled a large registry over a 27-year period using systematic identification and tracking strategies. A total of 1866 athletes who died suddenly (or survived cardiac arrest), 19±6 years of age, were identified throughout the United States from 1980 to 2006 in 38 diverse sports. Reports were less common during 1980 to 1993 (576 [31%]) than during 1994 to 2006 (1290 [69%], P <0.001) and increased at a rate of 6% per year. Sudden deaths were predominantly due to cardiovascular disease (1049 [56%]), but causes also included blunt trauma that caused structural damage (416 [22%]), commotio cordis (65 [3%]), and heat stroke (46 [2%]). Among the 1049 cardiovascular deaths, the highest number of events in a single year was 76 (2005 and 2006), with an average of 66 deaths per year (range 50 to 76) over the last 6 years; 29% occurred in blacks, 54% in high school students, and 82% with physical exertion during competition/training, whereas only 11% occurred in females (although this increased with time; P =0.023). The most common cardiovascular causes were hypertrophic cardiomyopathy (36%) and congenital coronary artery anomalies (17%). Conclusions— In this national registry, the absolute number of cardiovascular sudden deaths in young US athletes was somewhat higher than previous estimates but relatively low nevertheless, with a rate of <100 per year. These data are relevant to the current debate surrounding preparticipation screening programs with ECGs and also suggest the need for systematic and mandatory reporting of athlete sudden deaths to a national registry.

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Sudden Death in Young Athletes

2003-09-10

Barry J. Maron

This article summarizes the available information regarding the cardiac risks of participation in athletics. Hypertrophic cardiomyopathy remains the leading cause of sudden death from cardiac causes among young athletes. Although … This article summarizes the available information regarding the cardiac risks of participation in athletics. Hypertrophic cardiomyopathy remains the leading cause of sudden death from cardiac causes among young athletes. Although controlled studies are lacking, there is indirect evidence to suggest that screening and sidelining young athletes with high-risk cardiac findings are justified and should decrease the number of sudden deaths in this population.

Sudden Death in Young Adults: A 25-Year Review of Autopsies in Military Recruits

2004-12-07

Robert E. Eckart , Stephanie L. Scoville , Charles L. Campbell +5 more

Sudden death among military recruits is a rare but devastating occurrence. Because extensive medical data are available on this cross-sectional and diverse population, identification of the underlying causes of sudden … Sudden death among military recruits is a rare but devastating occurrence. Because extensive medical data are available on this cross-sectional and diverse population, identification of the underlying causes of sudden death may promote health care policy to reduce the incidence of sudden death.To determine the causes of nontraumatic sudden death among a cohort of military recruits.Retrospective cohort study using demographic and autopsy data from the Department of Defense Recruit Mortality Registry.Basic military training.All nontraumatic sudden deaths from a monitored 6.3 million men and women age 18 to 35 years.Descriptive analysis, crude mortality rates of causes of sudden death, and frequency of events as a function of cause of death.Of 126 nontraumatic sudden deaths (rate, 13.0/100,000 recruit-years), 108 (86%) were related to exercise. The most common cause of sudden death was an identifiable cardiac abnormality (64 of 126 recruits [51%]); however, a substantial number of deaths remained unexplained (44 of 126 recruits [35%]). The predominant structural cardiac abnormalities were coronary artery abnormalities (39 of 64 recruits [61%]), myocarditis (13 of 64 recruits [20%]), and hypertrophic cardiomyopathy (8 of 64 recruits [13%]). An anomalous coronary artery accounted for one third (21 of 64 recruits) of the cases in this cohort, and, in each, the left coronary artery arose from the right (anterior) sinus of Valsalva, coursing between the pulmonary artery and aorta.This cohort underwent a preenlistment screening program that included history and physical examination; this may have altered outcomes.Cardiac abnormalities are the leading identifiable cause of sudden death among military recruits; however, more than one third of sudden deaths remain unexplained after detailed medical investigation.

Histological Substrate of Atrial Biopsies in Patients With Lone Atrial Fibrillation

1997-08-19

Andrea Frustaci , Cristina Chimenti , Fulvio Bellocci +3 more

Lone atrial fibrillation (LAF) is a common clinical syndrome, but its origin remains unknown.We performed endomyocardial biopsies of the right atrial septum (2 to 3 per patient; mean, 2.8) and … Lone atrial fibrillation (LAF) is a common clinical syndrome, but its origin remains unknown.We performed endomyocardial biopsies of the right atrial septum (2 to 3 per patient; mean, 2.8) and of the two ventricles (6 per patient) in 12 patients (10 men, 2 women; mean age, 32 years) with paroxysmal LAF refractory to conventional antiarrhythmic treatment. As controls, we used endomyocardial biopsies (3 to 5 per patient; mean, 4.4) from the right atrial septum of 11 patients with Wolff-Parkinson-White syndrome (WPW) undergoing resection of the abnormal AV pathway. The weight of the biopsies ranged from 2.8 to 4.5 mg. Biopsy samples were processed for histology and electron microscopy and were read by a pathologist blinded to clinical data. All patients underwent two-dimensional Doppler echocardiography; cardiac catheterization; coronary angiography; and hormonal, virologic, and electrophysiological studies. All tests and WPW biopsies were normal, but all LAF atrial biopsy specimens (average, 2.8 per patient) showed abnormalities (P<.0001). The type of abnormalities varied: Two patients had a severe hypertrophy with vacuolar degeneration of the atrial myocytes and ultrastructural evidence of fibrillolysis occupying >50% of the areas assessed morphometrically (P=.50), 8 had lymphomononuclear infiltrates with necrosis of the adjacent myocytes (5 with fibrosis and 3 without; P<.003), and 2 had only nonspecific patchy fibrosis (P=.50). Biventricular biopsies were abnormal in only 3 patients and showed inflammatory infiltrates similar to those found in atrial biopsies.Abnormal atrial histology was uniformly found in multiple biopsy specimens in all patients with LAF. It was compatible with a diagnosis of myocarditis in 66% of patients (active in 25%) and of noninflammatory localized cardiomyopathy in 17% and was represented by patchy fibrosis in 17%. The cause of the pathological changes, which were found only in atrial septal biopsies but not in biventricular biopsies, in 75% of patients remains unknown.

Does sports activity enhance the risk of sudden death in adolescents and young adults?

2003-12-01

Domenico Corrado , Cristina Basso , Giulio Rizzoli +2 more

Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Task Force of the Working Group Myocardial and Pericardial Disease of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of the International Society and Federation of Cardiology.

1994-03-01

William J. McKenna , Gaetano Thiene , Andrea Nava +4 more

Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Task Force of the Working Group Myocardial and Pericardial Disease of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of … Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Task Force of the Working Group Myocardial and Pericardial Disease of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of the International Society and Federation of Cardiology.

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Recommendations for interpretation of 12-lead electrocardiogram in the athlete

2009-11-20

Domenico Corrado , Antonio Pelliccia , Hein Heidbüchel +7 more

Cardiovascular remodelling in the conditioned athlete is frequently associated with physiological ECG changes. Abnormalities, however, may be detected which represent expression of an underlying heart disease that puts the athlete … Cardiovascular remodelling in the conditioned athlete is frequently associated with physiological ECG changes. Abnormalities, however, may be detected which represent expression of an underlying heart disease that puts the athlete at risk of arrhythmic cardiac arrest during sports. It is mandatory that ECG changes resulting from intensive physical training are distinguished from abnormalities which reflect a potential cardiac pathology. The present article represents the consensus statement of an international panel of cardiologists and sports medical physicians with expertise in the fields of electrocardiography, imaging, inherited cardiovascular disease, cardiovascular pathology, and management of young competitive athletes. The document provides cardiologists and sports medical physicians with a modern approach to correct interpretation of 12-lead ECG in the athlete and emerging understanding of incomplete penetrance of inherited cardiovascular disease. When the ECG of an athlete is examined, the main objective is to distinguish between physiological patterns that should cause no alarm and those that require action and/or additional testing to exclude (or confirm) the suspicion of an underlying cardiovascular condition carrying the risk of sudden death during sports. The aim of the present position paper is to provide a framework for this distinction. For every ECG abnormality, the document focuses on the ensuing clinical work-up required for differential diagnosis and clinical assessment. When appropriate the referral options for risk stratification and cardiovascular management of the athlete are briefly addressed.

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Evidence for Cardiomyocyte Renewal in Humans

2009-04-02

Olaf Bergmann , Ratan D. Bhardwaj , Samuel Bernard +7 more

It has been difficult to establish whether we are limited to the heart muscle cells we are born with or if cardiomyocytes are generated also later in life. We have … It has been difficult to establish whether we are limited to the heart muscle cells we are born with or if cardiomyocytes are generated also later in life. We have taken advantage of the integration of carbon-14, generated by nuclear bomb tests during the Cold War, into DNA to establish the age of cardiomyocytes in humans. We report that cardiomyocytes renew, with a gradual decrease from 1% turning over annually at the age of 25 to 0.45% at the age of 75. Fewer than 50% of cardiomyocytes are exchanged during a normal life span. The capacity to generate cardiomyocytes in the adult human heart suggests that it may be rational to work toward the development of therapeutic strategies aimed at stimulating this process in cardiac pathologies.

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Percutaneous Coronary Angioplasty Compared With Exercise Training in Patients With Stable Coronary Artery Disease

2004-03-09

Rainer Hambrecht , Claudia Walther , Sven Möbius‐Winkler +7 more

Background— Regular exercise in patients with stable coronary artery disease has been shown to improve myocardial perfusion and to retard disease progression. We therefore conducted a randomized study to compare … Background— Regular exercise in patients with stable coronary artery disease has been shown to improve myocardial perfusion and to retard disease progression. We therefore conducted a randomized study to compare the effects of exercise training versus standard percutaneous coronary intervention (PCI) with stenting on clinical symptoms, angina-free exercise capacity, myocardial perfusion, cost-effectiveness, and frequency of a combined clinical end point (death of cardiac cause, stroke, CABG, angioplasty, acute myocardial infarction, and worsening angina with objective evidence resulting in hospitalization). Methods and Results— A total of 101 male patients aged ≤70 years were recruited after routine coronary angiography and randomized to 12 months of exercise training (20 minutes of bicycle ergometry per day) or to PCI. Cost efficiency was calculated as the average expense (in US dollars) needed to improve the Canadian Cardiovascular Society class by 1 class. Exercise training was associated with a higher event-free survival (88% versus 70% in the PCI group, P =0.023) and increased maximal oxygen uptake (+16%, from 22.7±0.7 to 26.2±0.8 mL O 2 /kg, P <0.001 versus baseline, P <0.001 versus PCI group after 12 months). To gain 1 Canadian Cardiovascular Society class, $6956 was spent in the PCI group versus $3429 in the training group ( P <0.001). Conclusions— Compared with PCI, a 12-month program of regular physical exercise in selected patients with stable coronary artery disease resulted in superior event-free survival and exercise capacity at lower costs, notably owing to reduced rehospitalizations and repeat revascularizations.

Identification of mutations in the cardiac ryanodine receptor gene in families affected with arrhythmogenic right ventricular cardiomyopathy type 2 (ARVD2)

2001-02-01

Natascia Tiso

Arrhythmogenic right ventricular dysplasia type 2 (ARVD2, OMIM 600996) is an autosomal dominant cardiomyopathy, characterized by partial degeneration of the myocardium of the right ventricle, electrical instability and sudden death. … Arrhythmogenic right ventricular dysplasia type 2 (ARVD2, OMIM 600996) is an autosomal dominant cardiomyopathy, characterized by partial degeneration of the myocardium of the right ventricle, electrical instability and sudden death. The disease locus was mapped to chromosome 1q42–q43. We report here on the physical mapping of the critical ARVD2 region, exclusion of two candidate genes (actinin 2 and nidogen), elucidation of the genomic structure of the cardiac ryanodine receptor gene (RYR2) and identification of RYR2 mutations in four independent families. In myocardial cells, the RyR2 protein, activated by Ca2+, induces the release of calcium from the sarcoplasmic reticulum into the cytosol. RyR2 is the cardiac counterpart of RyR1, the skeletal muscle ryanodine receptor, involved in malignant hyperthermia (MH) susceptibility and in central core disease (CCD). The RyR2 mutations detected in the present study occurred in two highly conserved regions, strictly corresponding to those where mutations causing MH or CCD are clustered in the RYR1 gene. The detection of RyR2 mutations causing ARVD2, reported in this paper, opens the way to pre-symptomatic detection of carriers of the disease in childhood, thus enabling early monitoring and treatment.

Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

2010-02-20

Gregory M. Marcus , William J. McKenna , Duane L. Sherrill +7 more

Background— In 1994, an International Task Force proposed criteria for the clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) that facilitated recognition and interpretation of the frequently nonspecific clinical features … Background— In 1994, an International Task Force proposed criteria for the clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) that facilitated recognition and interpretation of the frequently nonspecific clinical features of ARVC/D. This enabled confirmatory clinical diagnosis in index cases through exclusion of phenocopies and provided a standard on which clinical research and genetic studies could be based. Structural, histological, electrocardiographic, arrhythmic, and familial features of the disease were incorporated into the criteria, subdivided into major and minor categories according to the specificity of their association with ARVC/D. At that time, clinical experience with ARVC/D was dominated by symptomatic index cases and sudden cardiac death victims—the overt or severe end of the disease spectrum. Consequently, the 1994 criteria were highly specific but lacked sensitivity for early and familial disease. Methods and Results— Revision of the diagnostic criteria provides guidance on the role of emerging diagnostic modalities and advances in the genetics of ARVC/D. The criteria have been modified to incorporate new knowledge and technology to improve diagnostic sensitivity, but with the important requisite of maintaining diagnostic specificity. The approach of classifying structural, histological, electrocardiographic, arrhythmic, and genetic features of the disease as major and minor criteria has been maintained. In this modification of the Task Force criteria, quantitative criteria are proposed and abnormalities are defined on the basis of comparison with normal subject data. Conclusions— The present modifications of the Task Force Criteria represent a working framework to improve the diagnosis and management of this condition. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00024505.

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Identification of a deletion in plakoglobin in arrhythmogenic right ventricular cardiomyopathy with palmoplantar keratoderma and woolly hair (Naxos disease)

2000-06-01

Godfrina McKoy , Nikos Protonotarios , Andrew H. Crosby +7 more

PHYSICAL ACTIVITY AS AN INDEX OF HEART ATTACK RISK IN COLLEGE ALUMNI1

1978-09-01

Ralph S. Paffenbarger , Alvin L. Wing , Robert T. Hyde

Risk of first heart attack was found to be related Inversely to energy expenditure reported by 16,936 Harvard male alumni, aged 35–74 years, of whom 572 experienced heart attacks In … Risk of first heart attack was found to be related Inversely to energy expenditure reported by 16,936 Harvard male alumni, aged 35–74 years, of whom 572 experienced heart attacks In 117,680 person-years of followup. Stairs climbed, blocks walked, strenuous sports played, and a composite physical activity Index all opposed risk. Men with Index below 2000 kilocalories per week were at 64% higher risk than classmates with higher Index. Adult exercise was Independent of other influences on heart attack risk, and peak exertion as strenuous sports play enhanced the effect of total energy expenditure. Notably, alumni physical activity supplanted student athleticism assessed in college 16–50 years earlier. If it Is postulated that varsity athlete status implies selective cardiovascular fitness, such selection alone Is insufficient to explain lower heart attack risk in later adult years. Ex-varsity athletes retained lower risk only If they maintained a high physical activity Index as alumni.

Prevalence of Hypertrophic Cardiomyopathy in a General Population of Young Adults

1995-08-15

Barry J. Maron , Julius M. Gardin , John M. Flack +3 more

Hypertrophic cardiomyopathy (HCM) is a genetically transmitted disease and an important cause of morbidity and sudden cardiac death in young people, including competitive athletes. At present, however, few data exist … Hypertrophic cardiomyopathy (HCM) is a genetically transmitted disease and an important cause of morbidity and sudden cardiac death in young people, including competitive athletes. At present, however, few data exist to estimate the prevalence of this disease in large populations.As part of the Coronary Artery Risk Development in (Young) Adults (CARDIA) Study, an epidemiological study of coronary risk factors, 4111 men and women 23 to 35 years of age selected from the general population of four urban centers had technically satisfactory echocardiographic studies during 1987 through 1988. Probable or definite echocardiographic evidence of HCM was present in 7 subjects (0.17%) on the basis of identification of a hypertrophied, nondilated left ventricle and maximal wall thickness > or = 15 mm that were not associated with systemic hypertension. Prevalence in men and women was 0.26:0.09%; in blacks and whites, 0.24:0.10%. Ventricular septal thickness was 15 to 21 mm (mean, 17 mm) in the 7 subjects. Only 1 of the 7 subjects had ever experienced important cardiac symptoms attributable to HCM, had previously been suspected of having cardiovascular disease, or had obstruction to left ventricular outflow; 4 other subjects had relatively mild systolic anterior motion of the mitral valve that was insufficient to produce dynamic basal outflow obstruction. ECGs were abnormal in 5 of the 7 subjects. Five other study subjects had left ventricular wall thicknesses of 15 to 21 mm that were a consequence of systemic hypertension.HCM was present in about 2 of 1000 young adults. These unique population-based data will aid in assessments of the impact of HCM-related mortality and morbidity in the general population and the practicality of screening large populations for HCM, including those comprising competitive athletes.

Resistance Exercise in Individuals With and Without Cardiovascular Disease

2000-02-22

Michael L. Pollock , Barry A. Franklin , Gary Balady +7 more

A lthough exercise programs have traditionally empha- sized dynamic lower-extremity exercise, research increasingly suggests that complementary resistance training, when appropriately prescribed and supervised, has favorable effects on muscular strength and … A lthough exercise programs have traditionally empha- sized dynamic lower-extremity exercise, research increasingly suggests that complementary resistance training, when appropriately prescribed and supervised, has favorable effects on muscular strength and endurance, cardiovascular function, metabolism, coronary risk factors, and psychosocial well-being.This advisory reviews the role of resistance training in persons with and without cardiovascular disease, with specific reference to health and fitness benefits, rationale, the complementary role of stretching, relevant physiological considerations, and safety.Participation criteria and prescriptive guidelines are also provided.

Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update

2007-03-13

Barry J. Maron , Paul M. Thompson , Michael J. Ackerman +7 more

Recommendations for competitive sports participation in athletes with cardiovascular disease: A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology

2005-04-28

Antonio Pelliccia , R. Fagard , Hans Halvor Björnstad +7 more

A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of … A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology.

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The Athlete’s Heart

2000-01-25

Babette M Pluim , Aeilko H. Zwinderman , Arnoud van der Laarse +1 more

Background —It has been postulated that depending on the type of exercise performed, 2 different morphological forms of athlete’s heart may be distinguished: a strength-trained heart and an endurance-trained heart. … Background —It has been postulated that depending on the type of exercise performed, 2 different morphological forms of athlete’s heart may be distinguished: a strength-trained heart and an endurance-trained heart. Individual studies have not tested this hypothesis satisfactorily. Methods and Results —The hypothesis of divergent cardiac adaptations in endurance-trained and strength-trained athletes was tested by applying meta-analytical techniques with the assumption of a random study effects model incorporating all published echocardiographic data on structure and function of male athletes engaged in purely dynamic (running) or static (weight lifting, power lifting, bodybuilding, throwing, wrestling) sports and combined dynamic and static sports (cycling and rowing). The analysis encompassed 59 studies and 1451 athletes. The overall mean relative left ventricular wall thickness of control subjects (0.36 mm) was significantly smaller than that of endurance-trained athletes (0.39 mm, P =0.001), combined endurance- and strength-trained athletes (0.40 mm, P =0.001), or strength-trained athletes (0.44 mm, P <0.001). There was a significant difference between the 3 groups of athletes and control subjects with respect to left ventricular internal diameter ( P <0.001), posterior wall thickness ( P <0.001), and interventricular septum thickness ( P <0.001). In addition, endurance-trained athletes and strength-trained athletes differed significantly with respect to mean relative wall thickness (0.39 versus 0.44, P =0.006) and interventricular septum thickness (10.5 versus 11.8 mm, P =0.005) and showed a trend toward a difference with respect to posterior wall thickness (10.3 versus 11.0 mm, P =0.078) and left ventricular internal diameter (53.7 versus 52.1 mm, P =0.055). With respect to cardiac function, there were no significant differences between athletes and control subjects in left ventricular ejection fraction, fractional shortening, and E/A ratio. Conclusions —Results of this meta-analysis regarding athlete’s heart confirm the hypothesis of divergent cardiac adaptations in dynamic and static sports. Overall, athlete’s heart demonstrated normal systolic and diastolic cardiac functions.

The Upper Limit of Physiologic Cardiac Hypertrophy in Highly Trained Elite Athletes

1991-01-31

Antonio Pelliccia , Barry J. Maron , Antonio Spataro +2 more

In some highly trained athletes, the thickness of the left ventricular wall may increase as a consequence of exercise training and resemble that found in cardiac diseases associated with left … In some highly trained athletes, the thickness of the left ventricular wall may increase as a consequence of exercise training and resemble that found in cardiac diseases associated with left ventricular hypertrophy, such as hypertrophic cardiomyopathy. In these athletes, the differential diagnosis between physiologic and pathologic hypertrophy may be difficult.

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Triggering of Sudden Death from Cardiac Causes by Vigorous Exertion

2000-11-09

Christine M. Albert , Murray A. Mittleman , Claudia U. Chae +3 more

Retrospective and cross-sectional data suggest that vigorous exertion can trigger cardiac arrest or sudden death and that habitual exercise may diminish this risk. However, the role of physical activity in … Retrospective and cross-sectional data suggest that vigorous exertion can trigger cardiac arrest or sudden death and that habitual exercise may diminish this risk. However, the role of physical activity in precipitating or preventing sudden death from cardiac causes has not been assessed prospectively in a large number of subjects.

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The Incidence of Primary Cardiac Arrest during Vigorous Exercise

1984-10-04

David S. Siscovick , Noel S. Weiss , Robert H. Fletcher +1 more

To examine the risk of primary cardiac arrest during vigorous exercise, we interviewed the wives of 133 men without known prior heart disease who had had primary cardiac arrest. Cases … To examine the risk of primary cardiac arrest during vigorous exercise, we interviewed the wives of 133 men without known prior heart disease who had had primary cardiac arrest. Cases were classified according to their activity at the time of cardiac arrest and the amount of their habitual vigorous activity. From interviews with wives of a random sample of healthy men, we estimated the amount of time members of the community spent in vigorous activity. Among men with low levels of habitual activity, the relative risk of cardiac arrest during exercise compared with that at other times was 56 (95 per cent confidence limits, 23 to 131). The risk during exercise among men at the highest level of habitual activity was also elevated, but only by a factor of 5 (95 per cent confidence limits, 2 to 14). However, among the habitually vigorous men, the overall risk of cardiac arrest--i.e., during and not during vigorous activity--was only 40 per cent that of the sedentary men (95 per cent confidence limits, 0.23 to 0.67). Although the risk of primary cardiac arrest is transiently increased during vigorous exercise, habitual vigorous exercise is associated with an overall decreased risk of primary cardiac arrest.The risk of cardiac arrest during vigorous exercise is examined in the context of the relationship between the risk of cardiac arrest and vigorous exercise in general. The data concern 133 men who had primary cardiac arrest in Washington State between 1979 and 1981 and a control group of healthy men. The data were obtained through interviews with the men's wives. The results indicate that the risk of cardiac arrest during exercise is higher than at other times, especially among those with low levels of habitual activity; however, among habitually vigorous men, the overall risk of cardiac arrest (during and not during vigorous activity) is only 40 percent that of sedentary men.

Prognostic Value of Exercise Testing Soon after Myocardial Infarction

1979-08-16

Pierre Théroux , David D. Waters , C Halphen +2 more

The prognostic value of a limited treadmill exercise test performed one day before hospital discharge after acute myocardial infarction was studied in 210 consecutive patients who had no overt heart … The prognostic value of a limited treadmill exercise test performed one day before hospital discharge after acute myocardial infarction was studied in 210 consecutive patients who had no overt heart failure and had been free of chest pain for at least four days. No complications occurred. During a one-year follow-up period 28 of 43 patients (65 per cent) who had chest pain during the test reported angina, as compared with 60 of 167 (36 per cent) who had no chest pain during the test (P<0.001). The one-year mortality rates were 2.1 per cent (three of 146) in patients without changes in the S — T segment during exercise and 27 per cent (17 of 64) in those with depression of the S — T segment (P<0.001). Sudden death occurred in one of 146 (0.7 per cent) patients who showed no change in the S — T segment and in 10 of 64 (16 per cent) with depression of the segment (P<0.001). Thus, a limited treadmill exercise test performed before hospital discharge after acute myocardial infarction is safe and can predict mortality in the subsequent year. (N Engl J Med 301:341–345, 1979)

Exercise and Acute Cardiovascular Events

2007-04-28

Paul M. Thompson , Barry A. Franklin , Gary Balady +7 more

Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. … Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No strategies have been adequately studied to evaluate their ability to reduce exercise-related acute cardiovascular events. Maintaining physical fitness through regular physical activity may help to reduce events because a disproportionate number of events occur in least physically active subjects performing unaccustomed physical activity. Other strategies, such as screening patients before participation in exercise, excluding high-risk patients from certain activities, promptly evaluating possible prodromal symptoms, training fitness personnel for emergencies, and encouraging patients to avoid high-risk activities, appear prudent but have not been systematically evaluated.

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THE EFFECT OF CORONARY OCCLUSION ON MYOCARDIAL CONTRACTION

1935-05-31

Robert Tennant , Carl J. Wiggers

Arrhythmogenic right ventricular cardiomyopathy

2009-04-01

Cristina Basso , Domenico Corrado , Gregory M. Marcus +2 more

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

2019-05-16

Claudia L. Reardon , Brian Hainline , Cindy Miller Aron +7 more

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as … Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

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ST-Segment Elevation in Patients with Covid-19 — A Case Series

2020-04-17

Sripal Bangalore , Atul Sharma , Alexander J. Slotwiner +7 more

ST-Segment Elevation in Covid-19 Eighteen patients with Covid-19 presented with ST-segment elevation on ECG or had it develop during hospitalization. Eight patients received a diagnosis of acute my... ST-Segment Elevation in Covid-19 Eighteen patients with Covid-19 presented with ST-segment elevation on ECG or had it develop during hospitalization. Eight patients received a diagnosis of acute my...

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2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

2020-07-10

Antonio Pelliccia , Sanjay Sharma , Sabiha Gati +7 more

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their … The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol

2006-10-31

Eva Prescott

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Medicine and science in sports and exercise

1994-08-01

Sports fans: Measuring degree of identification with their team.

1993-01-01

Daniel L. Wann , Nyla R. Branscombe

Atrial fibrillation in former world-class rowers: role of environmental and genetic factors

2025-06-25

D. Flannery , Rodrigo Cánovas , Kristel Janssens +7 more | European Heart Journal

Abstract Background and Aims Endurance sport has been associated with an increased risk of atrial fibrillation (AF). The aim of this study was to assess the extent to which this … Abstract Background and Aims Endurance sport has been associated with an increased risk of atrial fibrillation (AF). The aim of this study was to assess the extent to which this is due to exercise burden or genetic predisposition. Methods Former rowers aged 45–80 years who competed at international championships were compared with a control group extracted from the UK Biobank, matched (1:100) for age and sex. Evaluation included 12-lead and Holter electrocardiograms, cardiac magnetic resonance imaging, and genetic analyses including rare variant evaluation and derivation of a validated AF polygenic risk score (AF-PRS). Results Of 121 rowers [age 62 years (interquartile range 54–69), 74% male], 26 (21.5%) had AF as compared with 364 of 11 495 control subjects (3.2%), prevalence risk ratio 6.8 [95% confidence interval (CI) 4.7–9.8]. Incident AF over 4-year follow-up was also greater [6 of 95 rowers (6.3%) vs 252 of 11 131 controls (2.3%), hazard ratio 2.8 (95% CI 1.6–5.0)]. Compared with controls, athletes demonstrated greater structural and electrophysiological cardiac remodelling. Athletes had similar cardiovascular risk factor profiles but a higher stroke prevalence than controls [3.3% vs 1.1%, risk ratio 3.0 (95% CI 1.1–7.9)]. Rare pathogenic and likely pathogenic variants in cardiomyopathy genes had low prevalence in athletes (2.7%) and were not enriched in those with AF. In contrast, in those subjects with a high AF-PRS (defined by the upper quartile in a healthy reference population) the odds of having AF increased 3.7-fold in athletes (95% CI 1.5–9.4) and 2.0-fold in controls (95% CI 1.7–2.4; P = .37 for between-group comparisons). Conclusions Despite having a favourable cardiovascular risk factor profile compared with controls, elite endurance athletes had a markedly higher prevalence and incidence of AF. These data suggest that exercise-induced cardiac remodelling and genetic susceptibility contribute to AF in endurance athletes.

Herzstillstand auf der Strecke: Wie gefährlich ist ein (Halb-)Marathon?

2025-06-24

Philipp Grätzel von Grätz | CardioVasc

Changes in plasma concentration of cell-free DNA as a response to physical activity

2025-06-22

Jaroslav A. Hubáček , Dana Dlouhá , Hana Štorkánová +6 more | Archives of Medical Science

Introduction Plasma concentrations of cell-free DNA (cfDNA) serve as markers of overtraining or muscle injury. We have examined, if nuclear (n) and mitochondrial (mt) cfDNA has the potential as a … Introduction Plasma concentrations of cell-free DNA (cfDNA) serve as markers of overtraining or muscle injury. We have examined, if nuclear (n) and mitochondrial (mt) cfDNA has the potential as a marker of muscle burden or damage. Material and methods Ten healthy, physically active volunteers (6 females, aged 27.1±6.8 years) performed a downhill running test. Samples for cfnDNA and cfmtDNA analysis were collected before, 30 minutes, 1 hour, and 14 days after the downhill run. CfnDNA and cfmtDNA (two markers for both) were analysed using qPCR. Results There was an extreme (~ 40-times) increase in cfnDNA at the 30-min time-point against the baseline (p<0.00001 for both markers), followed by a quick drop to baseline levels after 1 hour after the end of the downhill run for all subjects. In contrast, plasma levels of cfmtDNA did not increase significantly (p=0.27 and 0.12). It reflects the fact, that in 6 subjects, the pattern was similar as for cfnDNA but in 4 subjects rather a decrease of cfmtDNA concentration was observed at the 30-mi time-point. These differences correlate with age, BMI, and sex of the participants. Plasma cfnDNA significantly (p<0.01 for all) correlated with concentrations of muscle damage markers such as AST, ALT, and lactate dehydrogenase, and chemokines MIP-1α and IP-10 (positive). No homogenous correlation between cfmtDNA and biomarkers was detected. Conclusions Our study confirms the extreme release and clearance of cfnDNA in physically active subjects after strenuous exercise. In contrast, the trajectory of cfmtDNA concentrations seems to have much higher inter-individual variability than cfnDNA concentrations.

Distinct Myocardial Remodelling Profiles in Athletes: A Comparative Analysis Across Sporting Disciplines

2025-06-20

Waleed Hassan Almalki | Journal of Cardiovascular Translational Research

Bat's wings of pulmonary oedema

2025-06-20

Tornike Mshvildadze | Radiopaedia.org

Late-phase depolarization and repolarization abnormalities in english bulldogs with phenotypic expression of arrhythmogenic cardiomyopathy

2025-06-20

Mara Bagardi , M. Perego , Fabio Colombo +5 more | Veterinary Research Communications

Effects of Acute Exercise Bouts on Cardiovascular Biomarkers in Runners with Exercise-Induced Hypertension

2025-06-20

Young-Joo Kim , Han Soo Park , Sanghyun Nam +5 more | Sports

Exercise-induced hypertension (EIH) has increasingly been observed among middle-aged long-distance runners, raising concerns about cardiovascular risk. This study aimed to investigate acute changes in cardiovascular biomarkers associated with vascular inflammation, … Exercise-induced hypertension (EIH) has increasingly been observed among middle-aged long-distance runners, raising concerns about cardiovascular risk. This study aimed to investigate acute changes in cardiovascular biomarkers associated with vascular inflammation, oxidative stress, antioxidant defense, endothelial function, and myocardial burden in runners with EIH. Thirty-seven middle-aged male runners (aged 40–65 years) were categorized into a normal blood pressure group (NBPG; systolic blood pressure <210 mmHg, n = 23) and an EIH group (EIHG; ≥210 mmHg, n = 14) based on maximal systolic blood pressure during a graded exercise test (GXT). Participants performed a 30 min treadmill run at 80% heart rate reserve, and blood samples were collected before and after exercise. The biomarkers analyzed included high-sensitivity C-reactive protein (hs-CRP), derivatives of reactive oxygen metabolites (d-ROMs), biological antioxidant potential (BAP), nitric oxide (NO), superoxide dismutase (SOD), and N-terminal pro-brain natriuretic peptide (NT-proBNP). The results show that the EIHG exhibited increased NT-proBNP and SOD levels, along with a reduced NO response, indicating elevated myocardial stress and impaired vasodilation. hs-CRP was positively correlated with multiple hemodynamic indices, and SOD levels were associated with maximal systolic pressure and myocardial burden. These findings highlight the need for individualized monitoring and cardiovascular risk management in runners with EIH.

Triple imagen contráctil en el laboratorio de ecoestrés: el valor pronóstico adicional de las relaciones presión-volumen y trabajo latido reclutable por precarga

2025-06-19

Tonino Bombardini , Fausto Rigo , Ana Djordjevic‐Dikic +3 more | Revista Argentina de Cardiología

Introducción: La positividad del ecoestrés a través de alteraciones de la motilidad parietal ha ido cediendo terreno frente a nuevas propuestas basadas en la reserva contráctil del ventrículo izquierdo (índice … Introducción: La positividad del ecoestrés a través de alteraciones de la motilidad parietal ha ido cediendo terreno frente a nuevas propuestas basadas en la reserva contráctil del ventrículo izquierdo (índice stress/reposo de la elastancia ventricular izquierda). Por otra parte, la pendiente del trabajo latido reclutable por precarga, es decir, la pendiente de la relación trabajo latido y volumen de fin de diástole proporciona una medida independiente de la precarga y la poscarga.Objetivo: El propósito de este estudio fue evaluar el valor pronóstico adicional de la reserva contráctil ventricular izquierda y la pendiente del trabajo latido reclutable por precarga.Métodos: Se seleccionaron 692 pacientes de la base de datos del estudio multicéntrico de ecoestrés del Consejo Nacional de Investigaciones (Consiglio Nazionale delle Ricerche, CNR), con edad media de 62 ± 12 años, ecoestrés negativo (ejercicio = 130; dipiridamol = 438; dobutamina n = 124) y sin dilatación (n = 470) o miocardiopatía idiopática dilatada (n = 22). Todos los pacientes fueron sometidos a triple imagen: 1) evaluación de alteraciones de la motilidad parietal; 2) evaluación de la reserva contráctil ventricular izquierda; y 3) evaluación de la pendiente del trabajo latido reclutable por precarga.Resultados: De acuerdo a la norma de selección, todos los pacientes tuvieron un estudio de ecoestrés negativo según el criterio de motilidad parietal alterada; la tasa de positividad global fue de 49% para la reserva contráctil, 36% para la pendiente del trabajo latido reclutable por precarga (criterio de positividad ≤ 64 erg × cm−3 × 103), 19% para ambos criterios de positividad y 33% para ambos criterios de negatividad. En los 692 pacientes con una mediana de seguimiento de 20 meses, hubo 132 eventos.La tasa de eventos fue menor en pacientes con doble negatividad y mayor en aquellos con doble positividad (X2=51, p<0,001).Conclusiones: La tasa de positividad del ecoestrés y el rendimiento pronóstico aumentan marcadamente si la reserva contráctil con estrés y la pendiente del trabajo latido reclutable por precarga se suman a las alteraciones de motilidad parietal regional convencionales.

Impact of Neighborhood Factors on Exercise Capacity in Children With Hypertrophic Cardiomyopathy

2025-06-19

Imran Masood , Lei Wang , Helen M. Stanley +7 more | Circulation Heart Failure

BACKGROUND: Restricting certain patients with hypertrophic cardiomyopathy (HCM) from exercise likely has negative cardiovascular effects and has not been shown to reduce the risk of sudden cardiac death. Promoting exercise … BACKGROUND: Restricting certain patients with hypertrophic cardiomyopathy (HCM) from exercise likely has negative cardiovascular effects and has not been shown to reduce the risk of sudden cardiac death. Promoting exercise in children with HCM is complex and requires knowledge of the environmental factors that impact exercise capacity in children with HCM. METHODS: This retrospective, cross-sectional analysis includes children with HCM who underwent exercise stress testing at a single, children’s tertiary-care center between 2000 and 2023. Addresses from contemporaneous exercise stress testing were accessed and geocoded to census tracts. The child opportunity index was the primary exposure of interest. Granular neighborhood measures including the walkability index, rural-urban commuting area codes, index of concentration at the extremes, and uniform crime reporting rates were measured. The primary outcome measure was peak oxygen consumption. Linear regression and multivariable analyses were performed. RESULTS: A total of 155 patients were identified who met inclusion criteria, 23% (n=35) of whom were female. The mean age at the time of exercise stress testing was 15.8±3.1 years. More than half of the included patients were from a high or very high child opportunity index (30%, n=46, and 35%, n=54, respectively). Most patients lived in urban environments (rural-urban commuting area codes score, 1 or 2, 96.7%, n=150). The mean peak oxygen consumption was 2159±906 mm/min, and the adjusted peak oxygen consumption was 35.5±9.3 mL/kg per min. A multivariate model adjusting for disease severity, age at diagnosis of HCM, race, and accounting for collinearity showed that low child opportunity index, higher levels of urbanization, and lower concentration of neighborhood wealth were independently associated with lower peak oxygen consumption. CONCLUSIONS: Our study identified previously unrecognized environmental determinants of exercise capacity in children with HCM, with lower child opportunity index, increased urbanization, and lower neighborhood wealth independently associated with lower exercise performance. Programs designed to increase physical activity levels and exercise performance in children with HCM should account for neighborhood and economic factors.

Effect of exercise intervention on quality of life and exercise capacity in patients with atrial fibrillation: a systematic review and network meta-analysis

2025-06-18

Yu-li Xi , Yan Zhang , Ling Han +7 more | Frontiers in Public Health

Background Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, can significantly increase stroke risk, heart failure, and reduce quality of life. Despite growing evidence on the benefits of exercise for … Background Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, can significantly increase stroke risk, heart failure, and reduce quality of life. Despite growing evidence on the benefits of exercise for AF patients, data heterogeneity and the lack of comparative studies on different exercise modalities limit the accuracy of clinical recommendations. Objective To compare the effects of different exercise regimens on AF and determine the most effective type of exercise for the treatment of AF. Methods We systematically searched PubMed/Medline, Embase, the Cochrane Library, and Web of Science for randomized controlled trials of exercise interventions in patients with AF aged 18 years and older. The Cochrane Collaboration Risk of Bias tool (RoB 2) was utilized to assess the risk of bias. We used R software to perform a network meta-analysis. The protocol has been registered with PROSPERO (Number CRD42024628296). Results A total of 1,477 participants from 16 randomized controlled trials were included in this network meta-analysis. The results indicated that mind–body exercise (MB) was the most effective in improving general health [mean difference (MD) = 12.26, 95% credible intervals (95% Crl): 6.47 to 18.04, surface under the cumulative ranking curve (SUCRA) = 76.31%] and 6-min walk test (MD = 104.80, 95% Crl: 44.25 to 165.10, SUCRA = 99.60%). Additionally, aerobic exercise (AE) was the most effective in increasing vitality (MD = 7.73, 95% Crl: 6.40 to 9.07, SUCRA = 88.07%). Conclusion This network meta-analysis found that MB had superior effects on general health and exercise capacity. AE significantly improved vitality, social functioning, and mental health, with particular benefits in improving vitality. Systematic review registration https://www.crd.york.ac.uk/prospero , identifier (CRD42024628296).

Spectrum of genetic variants and yield of genetic testing in Slovenian probands with suspected cardiomyopathies surviving sudden cardiac arrest

2025-06-18

Nina Vodnjov , Aleš Maver , Borut Petelin +1 more | Egyptian Journal of Forensic Sciences

Abstract Background Cardiomyopathies (CMs) present phenotypically on a spectrum and in a proportion of patients the initial presentation is sudden cardiac arrest (SCA). Studies performing genetic screening of SCA survivors … Abstract Background Cardiomyopathies (CMs) present phenotypically on a spectrum and in a proportion of patients the initial presentation is sudden cardiac arrest (SCA). Studies performing genetic screening of SCA survivors have identified (likely) pathogenic (LP/P) variants in 2–50% of probands, with mean cohort ages ranging from 28 to 64 years. Due to inconsistent data in the literature, our study aimed to genetically characterise Slovenian SCA survivors with clinically confirmed/suspected cardiomyopathy (CM). The present study included 29 probands (17 women, 59%) with clinically confirmed/suspected CM who survived SCA and were referred to the Clinical Institute of Genomic Medicine for genetic testing between January 2010 and July 2024. The majority of probands (23; 79%) underwent whole exome sequencing, and the remainder either clinical exome (5; 17%) or panel sequencing (1; 4%). Genetic data were analysed following ACMG/AMP guidelines and ACGS recommendations. Results Probands survived SCA at a mean age of 49 ± 17 years (range 15–71), and 12 (41%) were < 50 years old. The majority had clinically confirmed/suspected arrhythmogenic (10; 34.5%) or dilated (9; 31.0%) CM, while the remainder had clinically undefined (5; 17.2%), hypertrophic (4; 13.8%), or non-compaction (1; 3.4%) CM. Seven LP/P variants in CM-related genes were identified in eight (28.6%) probands. In addition, 16 variants of uncertain significance (VUS) were identified in 12 (41.3%) probands. Probands’ age at SCA did not significantly affect the yield, as LP/P variants were identified in four probands < 50 years at SCA and in four > 50 years ( p = 0.56), nor did the positive family history of heart disease ( p = 0.55) or sudden cardiac death ( p = 0.43). There were also no significant differences in probands' age and test outcome, as the mean age of patients with LP/P variants was 46 ± 21 years, those with the VUS(s) were 45 ± 15 years, and those without candidate variant(s) were 55 ± 12 years ( p = 0.41). Conclusions LP/P variants were identified in almost one-third of Slovenian SCA survivors with clinically confirmed/suspected CM. Genetic testing of SCA survivors with structural clinical findings provides additional confirmation of the clinical diagnosis and a basis for identifying relatives at risk of heart disease, allowing for better management.

Cardiovascular adaptations in judo: a narrative review

2025-06-18

Carlo Rossi , Valerio Giustino , Antonino Patti +6 more | Frontiers in Sports and Active Living

Judo is a high-intensity combat sport requiring substantial aerobic and anaerobic capacity. Although research has explored the physiological demands of different sports over the years, few studies have investigated the … Judo is a high-intensity combat sport requiring substantial aerobic and anaerobic capacity. Although research has explored the physiological demands of different sports over the years, few studies have investigated the specific cardiovascular adaptations that occur in judoka. This narrative review examines these adaptations by focusing on cardiac function, heart rate variability (HRV), and hemodynamic responses, with the aim of summarizing the effects of judoka training on cardiovascular health and the relationship with athletic performance. Judo training improves aerobic capacity, with VO 2 max values similar to those of team sports athletes. It stimulates physiological hypertrophy of the left ventricle, improving cardiac function. Autonomic regulation shows a parasympathetic predominance, indicating better stress adaptation. Vascular adaptations include increased arterial elasticity and optimal blood pressure management, with judoka exhibiting lower blood pressure values than the general population. In summary, these adaptations promote cardiovascular health and improve athletic performance, although monitoring is essential to prevent overtraining and long-term issues.

Prevalence of cardiovascular pathology in athletes

2025-06-18

В. А. Бадтиева , Н В Сичинава , Н. Г. Трухачева +6 more | Sports medicine research and practice

Purpose of the study: the purpose of the study was to identify and find out the prevalence of cardiovascular pathology, as well as changes in the cardiovascular system that require … Purpose of the study: the purpose of the study was to identify and find out the prevalence of cardiovascular pathology, as well as changes in the cardiovascular system that require monitoring and correction, in athletes of various skill levels. Materials and methods: we evaluated athletes — Moscow national team members who were underwent an in-depth medical examination during six years (2017–2022) in the department No. 1 (Sports Medicine Clinic) of the Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine. Results: the prevalence of cardiovascular diseases among the athletes was about 6 % with no signs of rising in 6 years follow up period. We also noted changes in cardiac diseases structure during the period 2017–2022. There were 1.93 % of high sudden cardiac death risk athletes who needed a deep additional investigation; 0.07 % of athletes were not permitted to sports. Conclusion: in-depth functional cardiovascular system assessment in athletes is very important to prevent life-threatening conditions and cases of sudden death.

Cardio-respiratory indicators and functional state of athletes after COVID-19

2025-06-18

Iu. M. Ivanova , В. А. Бадтиева , А. С. Шарыкин +2 more | Sports medicine research and practice

Purpose of the study: to assess the state of the cardiorespiratory system of athletes after the COVID-19 pandemic. Materials and methods: A total of 1096 athletes (492 women and 604 … Purpose of the study: to assess the state of the cardiorespiratory system of athletes after the COVID-19 pandemic. Materials and methods: A total of 1096 athletes (492 women and 604 men) over 15 years of age were examined in 28 sports. A clinical and instrumental assessment of the health of the athletes, a laboratory analysis by the polymerase chain reaction (PCR) method for the genetic material of the virus and the level of IgM and IgG antibodies to the SARS-CoV-2 virus, an assessment of the functional state of the cardiorespiratory system were carried out. Results: None of the athletes included in the study were hospitalized or had symptoms of pneumonia or cardiovascular problems. The period of self-isolation with limited self-training lasted from 2.5 to 3 months. After isolation, a decrease in the aerobic capacity of the athletes was noted. The peak oxygen consumption achieved during this period significantly decreased compared to the period before self-isolation in all types of sports disciplines. Conclusions: Athletes are at high risk of contracting coronavirus infection and require mandatory testing for the infection before being allowed to train and compete. The main consequence of self-isolation is a decrease in the predominantly aerobic performance of athletes, regardless of whether they have had COVID-19.

Anais do XI Encontro Científico do LABIMH e 2º Congresso Internacional de Clínica Médica e Exercício Físico

2025-06-18

Marcos Freitas Cordeiro | Evidência

Há mais de duas décadas, o Laboratório de Biociências da Motricidade Humana (LABIMH) tem sido um farol de inovação e descobertas em seu campo. Nossos pesquisadores e colaboradores têm trabalhado … Há mais de duas décadas, o Laboratório de Biociências da Motricidade Humana (LABIMH) tem sido um farol de inovação e descobertas em seu campo. Nossos pesquisadores e colaboradores têm trabalhado incansavelmente para entender melhor a relação entre a atividade física, a saúde humana e a medicina clínica. No ano de 2024, o nosso XI Encontro Científico e o 2º Congresso Internacional de Clínica Médica e Exercício Físico foi um dos nossos eventos mais impactantes e enriquecedores. Os participantes puderam desfrutar de uma programação diversificada que incluiu palestras de renomados cientistas e profissionais internacionais, qualificações e defesas de teses, sessões de apresentações de comunicação oral e oportunidades de networking.Além disso, nosso formato híbrido permitiu que os participantes escolhessem a melhor maneira de participar. Se estavam longe ou preferiram a comodidade de participar de casa, puderam acompanhar as apresentações e debates ao vivo em nosso canal do YouTube. Para aqueles que desejaram uma experiência presencial, o Auditório da Escola de Enfermagem Alfredo Pinto, localizado no Rio de Janeiro, esteve aberto para receber os participantes.Este foi um momento de se conectar com outros apaixonados pela pesquisa e pela promoção da saúde, de aprender com os melhores do campo e de colaborar para moldar o futuro da biociência da motricidade humana.Foi uma emocionante jornada de descobertas e avanços científicos, seja virtualmente ou presencialmente, e temos a certeza de que ajudamos a contribuir para o crescimento da ciência em prol da saúde e bem-estar humano. O futuro da pesquisa em biociências da motricidade humana começa aqui no LABIMH!

Family Screening in Relatives at Risk for Plakophilin-2–Associated Arrhythmogenic Right Ventricular Cardiomyopathy

2025-06-17

Steven A. Muller , Babken Asatryan , Alessio Gasperetti +7 more | Circulation

BACKGROUND: Penetrance and risk of ventricular arrhythmias (VAs) in arrhythmogenic right ventricular cardiomyopathy (ARVC) are increasingly recognized as being genotype specific. Therefore, genotype-informed family screening protocols may lead to safer … BACKGROUND: Penetrance and risk of ventricular arrhythmias (VAs) in arrhythmogenic right ventricular cardiomyopathy (ARVC) are increasingly recognized as being genotype specific. Therefore, genotype-informed family screening protocols may lead to safer and more personalized recommendations than the current one-size-fits-all screening recommendations. We aimed to develop a safe, evidence-based plakophilin-2 ( PKP2 )–specific longitudinal screening algorithm. METHODS: We included 295 relatives (41% male; age 30.9 years [18.0–47.7 years]) with a pathogenic or likely pathogenic PKP2 variant from 145 families. Phenotype was ascertained with ECG, Holter monitoring, and cardiac imaging and classified by the 2010 Task Force Criteria. VA was defined as a composite of sudden cardiac arrest or death, spontaneous sustained ventricular tachycardia, ventricular fibrillation, or appropriate implantable cardioverter defibrillator intervention. We performed Cox regression to determine predictors of ARVC development and multistate modeling to assess the probability of ARVC development and occurrence of VA. RESULTS: At baseline, 110 relatives (37%) had definite ARVC. During 8.5 years (4.2–12.9 years) of follow-up, 62 of 185 relatives (34%) without definite ARVC at baseline progressed to definite ARVC diagnosis, and 35 of 295 of all relatives (12%) had VA. VAs occurred only in relatives who previously fulfilled definite ARVC diagnosis. Relatives with borderline ARVC (fulfillment of one minor criterion plus the major family history criterion) progressed 5 times faster in the multistate model to definite ARVC diagnosis and compared with genotype-positive/phenotype-negative (G+/P−) relatives (ie, major family history criterion alone). Relatives 20 to 40 years of age had increased risk for developing definite ARVC (hazard ratio, 2.23; P =0.012) compared with those ≥40 years of age. New Task Force Criteria fulfillment most commonly occurred first on ECGs, followed by Holter monitoring and cardiac imaging. Consequently, 3 risk profiles were identified, and appropriate screening protocols were derived: relatives with borderline ARVC (annual ECG and Holter monitoring; complete evaluation [ie, ECGs, Holter monitoring, and imaging] every 2 years), younger (<40 years of age) or symptomatic G+/P− relatives (every 2 years an ECG and Holter monitoring; complete evaluation every 4 years), and older (≥40 years of age) and asymptomatic G+/P− relatives (complete evaluation every 5 years). CONCLUSIONS: An evidence-based longitudinal screening algorithm that integrates age, symptoms, and baseline clinical phenotype may improve patient care and improve efficiency of clinical resource allocation.

Machine Learning Models Enhance Prediction of Arrhythmogenic Right Ventricular Cardiomyopathy

2025-06-17

Kwaku Quansah , Sean Murphy , Eun-Kyung Kwon +5 more | medRxiv (Cold Spring Harbor Laboratory)

Abstract Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a leading contributor to sudden cardiac death worldwide, yet its diagnosis remains complex, expensive and time-consuming. Machine-learning (ML) classifiers offer a practical solution … Abstract Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a leading contributor to sudden cardiac death worldwide, yet its diagnosis remains complex, expensive and time-consuming. Machine-learning (ML) classifiers offer a practical solution by delivering rapid, scalable predictions that can lessen dependence on expert interpretation and speed clinical decision-making. Here, we benchmarked eight ML algorithms for ARVC detection using area-under-the-curve (AUC) and accuracy as primary metrics. Gradient Boosted Trees outperformed all other models, achieving an accuracy of 94.34% after rigorous cross-validation. These results underscore the promise of Gradient Boosted Trees classifier as an effective decision-support tool within the ARVC diagnostic workflow, with potential to streamline evaluation and improve patient outcomes.

Unmasking Myocardial Bridging: Multimodal Imaging and tailored medical approach in Exercise-Induced Angina – A Case Report

2025-06-17

Mattia Alexis Amico , Matteo Casini , Egidio Natalino Costanzo +2 more | Journal of the Saudi Heart Association

Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery runs intramyocardially. We present the case of a 38-year-old male with myocardial bridging in … Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery runs intramyocardially. We present the case of a 38-year-old male with myocardial bridging in the mid-left anterior descending artery who developed exercise-induced angina. This case underscores the importance of recognizing MB as a cause of ischemia that should not be overlooked in the diagnostic workup of patients with angina, especially in younger individuals. A comprehensive diagnostic approach, including multimodality imaging, is essential to uncover the pathology. A tailored pharmacological strategy is recommended. Long-term clinical follow-up is crucial for optimizing symptom management and reducing complications.

Incidence of cardiovascular risk factors and exercise phenotyping in cardiomyopathies: One size does not fit all

2025-06-17

Simon Wernhart , Florian Karcher , Mark J. Haykowsky +1 more | IJC Heart & Vasculature

Impact of COVID-19 infection on physical performance of soccer players: a systematic review

2025-06-16

Koulla Parpa , Marcos Michaelides , Ana Carolina Paludo +2 more | International Journal of Sports Medicine

Abstract This review sought to identify the impact of COVID-19 infection on the physical performance parameters of soccer players. The systematic review was conducted based on the PRISMA guidelines. The … Abstract This review sought to identify the impact of COVID-19 infection on the physical performance parameters of soccer players. The systematic review was conducted based on the PRISMA guidelines. The following databases were searched up to the end of October 2024: MEDLINE, Scopus, Mendeley, SPORTDiscus, and Google Scholar. Studies conducted on professional and semi-professional adult male soccer players were considered. For a study to be included, it had to report at least one outcome measure both before and after COVID-19 infection. At the end of the screening procedure, a total of 11 studies met the inclusion criteria. The reviewed studies on V̇O2 max showed mixed results. One study reported a significant (p<0.01) decrease 60 days post-infection, while others found no change or even an increase 1-year post-pandemic. Pulmonary function assessment revealed a significant (p<0.01) increase in respiratory work, whereas one study found no significant changes at rest. GPS (Global Positioning System) -based studies reported a significant (p<0.05) reduction in high-intensity accelerations, decelerations, and high-speed running post-COVID-19, while one study found no differences between infected and non-infected players. Strength, power, and anaerobic power showed no significant decline. These findings should be interpreted with caution due to the small sample sizes and limited number of studies.

Miocardite traumática em um cão por acidente automobilístico: relato de caso

2025-06-15

Patrick Eugênio Luz , Jaqueline Sayuri Medeiros Watanabe , Ana Paula Maingué +5 more | ACTA SCIENTIAE VETERINARIAE

Resumo: Miocardite é uma doença miocárdica com prognóstico ruim em cães e gatos, e sua etiologiapode ser infecciosa e não-infecciosa, como a miocardite traumática. A miocardite traumática érelacionada à arritmias … Resumo: Miocardite é uma doença miocárdica com prognóstico ruim em cães e gatos, e sua etiologiapode ser infecciosa e não-infecciosa, como a miocardite traumática. A miocardite traumática érelacionada à arritmias ventriculares e supraventriculares devido aos traumas torácicos após 24 a 48horas após o episódio. O diagnóstico é desafiador, frequentemente subdiagnosticado e ferramentascomo o Critério de Duke modificado pode ser usado para obter diagnóstico antemortem cominterpretação de dosagem de biomarcadores como a troponina I (TnI), ecocardiograma (ECO) eeletrocardiograma (ECG), achados de exame físico, e alterações hematológicas. No ECO pode-seencontrar disfunção sistólica e heteroecogenicidade do miocárdio no ventrículo esquerdo, e efusãopericárdica. Biomarcadores como a TnI tem alta especificidade para o tecido cardíaco e pode ser usadona triagem emergencial. A enzima creatinoquinase-MB (CK-MB) está presente no coração, rins, intestinoe pulmão, e também podem ser utilizados como exame adicional na investigação da miocardite. Oobjetivo é apresentar um caso raro de miocardite traumática. Caso: Uma canina de 9 anos, SRD,castrada, fêmea foi atendida no Hospital Veterinário da Universidade Estadual de Londrina (HV-UEL),Londrina, Paraná, Brasil, com o histórico de acidente automobilístico há 30 minutos. A paciente estavaconsciente e em decúbito lateral, midríase bilateral e dispneia mista. Na auscultação torácica foi notadocrepitação pulmonar e abafamento cardíaco. A paciente recebeu oxigenioterapia, metadona efluidoterapia. Na radiografia torácica havia contusão pulmonar e no T-faz, foi visto diminuição dacontração cardíaca, discreta efusão pleural e miocárdio heterogêneo e hiperecóico. No ECG foiencontrado taquicardia sinusal, bloqueio de ramo direito e taquicardia ventricular paroxística, então foiadministrado lidocaína. Pressão arterial sistêmica estava 50 mmHg, no que foi iniciado infusão contínuade dobutamina até a normalização. Os biomarcadores cardíacos TnI e CK-MB estavam elevados. Com odiagnóstico de miocardite traumática, o animal foi internado. No dia seguinte, a contusão pulmonarhavia melhorado. Quatro dia após, a paciente recebeu alta. Trinta dia após, havia normalizado asalterações radiográficas e eletrocardiográficas, o eletrocardiograma ainda se encontrava com bloqueiode ramo direito, porém com ritmo sinusal. Finalmente, os biomarcadores cardíacos estavam levementeaumentados. Discussão: A intervenção imediata no caso, permitiu a estabilização do paciente e odiagnóstico da contusão pulmonar pela radiografia torácica. Após o resultado do exame hematológico,ECG e ECO, permitiu o diagnóstico do animal com miocardite traumática usando o Critério de DukeModificado. Estudos observaram que as arritmias ventriculares são as alterações eletrocardiográficasmais comuns na miocardite, como foi observado nesse caso. O uso de corticosteroides não écomprovado quanto à sua eficácia, porém nós tivemos respostas positivas com o caso. No controle dahipotensão, dobutamina foi usado devido sua ação inotrópica positiva. O tratamento do hemotóraxdeve ser focado na perda sanguínea e fluídos. Pesquisas mostram que o CK-MB e TnI canina estavamaltas em dois pacientes com trauma cardíaco. Ambos os biomarcadores estavam altos no nosso relato.No retorno, os biomarcadores continuaram elevados, levando à suspeita que houve lesão cicatricialmiocárdica. A avaliação minuciosa do paciente é crucial para determinar cada passo de um atendimentoemergencial. A lesão miocárdica inicia uma série de eventos que podem levar à alterações de conduçãoelétrica e contração cardíaca, colocando o animal em risco de vida. Portanto, pacientes com histórico deacidente automobilístico devem ser submetidos a um completo exame torácico, incluindo radiografiatorácica, eletrocardiograma, ecocardiograma para possíveis alterações miocárdicas. E se possível, adosagem de biomarcadores cardíacos.

Comment on Bianco et al. Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population. J. Cardiovasc. Dev. Dis. 2025, 12, 22

2025-06-13

Daniel Neunhäeuserer , Francesca Battista , Giulia Quinto +3 more | Journal of Cardiovascular Development and Disease

The article by Bianco M [...] The article by Bianco M [...]

Arrhythmogenic cardiomyopathy in children: genetic basis and phenotypic manifestations. A single center experience

2025-06-13

O. А. Kofeynikova , K. A. Chueva , Anna Kostareva +4 more | Journal of Arrhythmology

Aim . To investigate clinical manifestations, phenotypic variants, genetic features, and outcomes in children with arrhythmogenic cardiomyopathy (ACM). Methods . The study group consisted of 24 patients (< 18 years … Aim . To investigate clinical manifestations, phenotypic variants, genetic features, and outcomes in children with arrhythmogenic cardiomyopathy (ACM). Methods . The study group consisted of 24 patients (< 18 years of age) with ACM, who were under observation from 2011 to 2024. The median age at ACM diagnosis was 13 years [12-15]. The following data were analyzed: complaints and medical history, laboratory parameters (biochemical markers of inflammation and serum myocardial damage mar kers, NT-proBNP levels), electrocardiogram, Holter monitoring, echocardiography results, cardiac magnetic resonance imaging, selective coronary angiography, histological and molecular genetic studies. The median follow-up duration for ACM patients was 27 months [16.5-38]. Results . All patients were unrelated probands. All children presented with asymptomatic ventricular arrhythmias (VA) as the initial manifestation of the disease, 23 (95.8%) patients had complaints: palpitations in 21 (87.5%) children, syncope in 14 (58.3%) children, heart failure symptoms in 12 (50.0%), and isolated chest pain in 4 (16.7%) patients. 5 (20.8%) children had a “hot” phase. Analysis of arrhythmic data revealed several features of ACM in childhood: VAs were polymorphic, daily VA density was less than 20% at the time of diagnosis, presence of late ventricular potentials in most patients, and several criteria from the «repolarization abnormalities» group had low informativeness. During follow-up, 9 (37.5%) children had the right-dominant ACM, 7 (29.9%) had ACM with left ventricle involvement, and 8 (33.3%) had biventricular form. Desmosomal mutations were found in 16 children (66.7%), non-desmosomal gene variants in 8 patients (33.3%). Conclusion . It has been shown that ACM can manifest at an early age and is associated with the development of arrhythmic events and/or severe heart failure. Increasing awareness among physicians about the early onset of ACM is crucial for timely treatment of heart failure, prevention of sudden cardiac death, and family screening.

Clinical manifestations of different viral respiratory infections in athletes: implications for risk assessment and return-to-sport - AWARE VII study in 116 cases

2025-06-13

Marcel Jooste , Nicola Sewry , Maarit Valtonen +3 more | The Physician and Sportsmedicine

The aims of this study were to describe the etiology of acute respiratory infections (ARinf) in athletic individuals, and to identify differences in the clinical presentation, evidence of possible multi-organ … The aims of this study were to describe the etiology of acute respiratory infections (ARinf) in athletic individuals, and to identify differences in the clinical presentation, evidence of possible multi-organ involvement, and illness classification between common pathogen groups. One-hundred-and-sixteen cases of confirmed ARinf in athletic individuals were evaluated ≤5 days of the onset of an ARinf. Nasopharyngeal swab multiplex PCR testing was performed to identify a causative pathogen. Symptomatology, clinical examination findings, results of selected blood tests, and the clinical syndrome and illness severity classifications were compared between four common pathogen groups. The etiologies of ARinf in this cohort were: rhinovirus = 34(29%), influenza = 17(15%), SARS-CoV-2 = 15(13%), common coronavirus = 13(11%), 'unidentified' = 16(14%), 'dual pathogen' = 9(8%), and 'other' = 12(10%). Clinical presentation differed among the four common pathogen groups as follows: Influenza had more total symptoms, lower respiratory & regional symptoms, and systemic & non-respiratory symptoms than rhinovirus (p ≤ 0.002) and common coronavirus (p < 0.05). Influenza and SARS-CoV-2 had higher total symptoms and systemic & non-respiratory symptom severity scores than rhinovirus (p ≤ 0.0006 and p < 0.03 respectively) and common coronavirus (p ≤ 0.03 and p = 0.02 respectively). Evidence of other non-respiratory organ involvement on clinical examination was highest for influenza (53%). Illness classification for pathogen groups differed: common coronavirus had the highest percentage (%) of rhinitis-like ('common cold') illnesses (69%), and influenza had the highest % of 'flu-like' illnesses (82%). Influenza had the highest % of severe illnesses (88%) and common coronavirus the lowest (31%). 41% of rhinovirus presented with severe illness. Influenza and SARS-CoV-2 had greater number and severity of symptoms than rhinovirus and common coronavirus. Among the four common pathogen groups, influenza had the highest percentage of abnormal clinical examination and serological findings and severe illnesses. Knowledge of the causative pathogen and the clinical presentation may add value to the risk assessment and guide clinical decision-making in return-to-sport following ARinf in athletic individuals.

Reply to Neunhaeuserer et al. Comment on “Bianco et al. Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population. J. Cardiovasc. Dev. Dis. 2025, 12, 22”

2025-06-13

Massimiliano Bianco , Fabrizio Sollazzo , Riccardo Pella +7 more | Journal of Cardiovascular Development and Disease

We have read the commentary on our article entitled ‘Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population’ [...] We have read the commentary on our article entitled ‘Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population’ [...]

High Physical Activity Level and the Long-Term Risk of Atrial Fibrillation in Two Swedish Cohorts

2025-06-12

Per Wändell , Malin Enarsson , Tobias Feldreich +3 more | Geriatrics

Background: Associations between high physical activity (PA) levels and incident atrial fibrillation (AF) is found in some earlier studies. We aim to study the association between levels of PA and … Background: Associations between high physical activity (PA) levels and incident atrial fibrillation (AF) is found in some earlier studies. We aim to study the association between levels of PA and AF in two cohorts. Methods: We used data from the Uppsala Longitudinal Study of Adult Men (ULSAM) study, initiated in 1970, included men aged 50 years, with 2202 included in the study. Examinations were reiterated three times, with follow-up after in median 33 years, with 3.8–6.0% on the highest PA level. We also used data from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; with women 50%); mean age 70 years, baseline 2001–2004, median follow-up 15 years, with 961 included in the study, with 4.8% on the highest PA level. Cox regression analysis with hazard ratios (HRs) was used to study association between PA levels and incident AF, adjusted for CV risk factors: systolic blood pressure, LDL- and HDL-cholesterol, BMI, diabetes, and smoking. Results: Totally, in ULSAM 504 men during 59,958 person-years at risk, and in PIVUS 204 individuals during a follow-up of 11,293 person-years experienced an AF. Neither in ULSAM, PIVUS, nor in the meta-analysis of both cohorts, individuals with the highest PA level showed an increased AF risk, compared to individuals with lowest level of PA. Conclusions: The benefits of PA in community dwelling individuals for its benefits to mental, metabolic, and cardiovascular health should guide public recommendations, rather than a possible risk of AF. Lay Summary: We studied the risk of incident atrial fibrillation at various levels of physical activity in two cohorts and found no statistically significant increased risk after adjusting for cardiovascular risk factors (systolic blood pressure, LDL- and HDL-cholesterol, BMI, diabetes, and smoking).

Vaping and Lung Injury

2025-06-12

Ravindran Chetambath , Rameesa Shanavas | Journal of Advanced Lung Health

Muerte súbita en clubes deportivos de rugby

2025-06-10

Marío Fitz Maurice , Fernando Di Tommaso , María C. Pertuz +3 more | Revista Argentina de Cardiología

Introducción: La muerte súbita cardíaca representa aproximadamente el 12% de todas las muertes naturales y alrededor del 50% de las muertes de origen cardiovascular en los países desarrollados. La aparición … Introducción: La muerte súbita cardíaca representa aproximadamente el 12% de todas las muertes naturales y alrededor del 50% de las muertes de origen cardiovascular en los países desarrollados. La aparición del desfibrilador externo automático ha permitido comprender que su utilización precoz en conjunto con la reanimación cardíaca aumenta las chances de sobrevida a un 80% si esto se aplica en el primer minuto. Objetivos: Describir las características (disponibilidad actual de desfibriladores externos automáticos en la institución, cantidad de estos en la actualidad, su localización, presencia de señalización, disponibilidad de algoritmos de reanimación, casos en los cuales se requirió la utilización de uno) y la tasa de mortalidad por muerte súbita cardíaca en personas que concurren a eventos organizados en clubes de Rugby de Argentina. Material y métodos: Estudio retrospectivo descriptivo observacional y transversal en el cual se incluyeron 137 clubes de rugby pertenecientes a la Unión de Rugby de Buenos Aires y del interior, en los cuales durante enero de 2012 y julio de 2017 se llevó a cabo un programa de entrenamiento en resucitación cardiopulmonar a la comunidad y al personal no médico. Estos clubes previamente recibieron como donación un equipo de desfibrilador automático validado internacionalmente de marca Zoll, y en otros casos adquirieron mediante compra desfibriladores marca Cardiac Science. Se realizó seguimiento durante 5 años mediante contacto telefónico, a fin de registrar los eventos cardiovasculares ocurridos durante ese período y el uso dado al desfibrilador. Resultados: El desfibrilador externo automático fue utilizado en 7 de los 100 clubes con disponibilidad de este (7%), en total se usó en 8 pacientes. En el 88% de los casos la victima de muerte súbita fue un jugador, y en el 12% fue un espectador. La mortalidad en el campo fue del 25% (2 muertes en el campo), de los sobrevivientes, el 100% llegó vivo al hospital. La incidencia anual de muerte súbita en los jugadores de rugby fue 1,7/100.000. Conclusión: La implementación de programas de capacitación en maniobras de resucitación cardiopulmonar y el acceso a desfibriladores externos automáticos en clubes de rugby de la provincia de Buenos Aires demostró utilidad en el acceso precoz de víctimas de eventos de muerte súbita.

Epistasis in cardiac traits

2025-06-05

Julian Stamp , Lorin Crawford | Nature Cardiovascular Research

The protective role of competitive sports in reducing suicidality amongst youth athletes

2025-06-04

Paola R. Sparagana , Claire Clark , Whitney M. Herge +1 more | Frontiers in Psychology

Introduction Suicidality is a critical concern among young people, and a prevalent concern in athletes. This study aimed to investigate the rate of suicidality among youth athletes in sports medicine … Introduction Suicidality is a critical concern among young people, and a prevalent concern in athletes. This study aimed to investigate the rate of suicidality among youth athletes in sports medicine clinics and to evaluate the risk for suicidality in this population. Methods A retrospective chart review of 8,599 patients (10–18 years old) seen between 2018 and 2022 was conducted using the Ask Suicide-Screening Questionnaire (ASQ). Analyses examined relationships between ASQ responses and demographic, clinical, and sport-related variables. Results Amongst athletes, higher competition levels were associated with lower rates of suicidality than those competing at lower levels ( p = 0.0162). While female sex was associated with increased suicidality overall, this was not significant within the athlete subgroup. Discussion Higher levels of sport competition were associated with lower rates of suicidal ideation, suggesting a potential protective effect.

Accurate and efficient cardiac digital twin from surface ECGs: Insights into identifiability of ventricular conduction system

2025-06-03

Thomas Grandits , Karli Gillette , Gernot Plank +1 more

Digital twins for cardiac electrophysiology are an enabling technology for precision cardiology. Current forward models are advanced enough to simulate the cardiac electric activity under different pathophysiological conditions and accurately … Digital twins for cardiac electrophysiology are an enabling technology for precision cardiology. Current forward models are advanced enough to simulate the cardiac electric activity under different pathophysiological conditions and accurately replicate clinical signals like torso electrocardiograms (ECGs). In this work, we address the challenge of matching subject-specific QRS complexes using anatomically accurate, physiologically grounded cardiac digital twins. By fitting the initial conditions of a cardiac propagation model, our non-invasive method predicts activation patterns during sinus rhythm. For the first time, we demonstrate that distinct activation maps can generate identical surface ECGs. To address this non-uniqueness, we introduce a physiological prior based on the distribution of Purkinje-muscle junctions. Additionally, we develop a digital twin ensemble for probabilistic inference of cardiac activation. Our approach marks a significant advancement in the calibration of cardiac digital twins and enhances their credibility for clinical application.

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Exosomal miR-202-5p derived from iPSC-MSCs protects against myocardial infarction through inhibition of cardiomyocyte pyroptosis

2025-06-03

Jiaqi Chen , Xiaoting Liang , Qian Han +7 more | Stem Cell Research & Therapy

NOD-like receptor thermal protein domain associated protein 3 (NLRP3)-mediated pyroptosis of cardiomyocytes is a key contributor to the progression of myocardial infarction (MI). This study aimed to investigate whether exosomes … NOD-like receptor thermal protein domain associated protein 3 (NLRP3)-mediated pyroptosis of cardiomyocytes is a key contributor to the progression of myocardial infarction (MI). This study aimed to investigate whether exosomes derived from human induced pluripotent stem cell-derived mesenchymal stem cells (iPSC-MSC-EXOs) could protect against MI by inhibiting cardiomyocyte pyroptosis and explore the underlying mechanisms. Exosomes from human bone marrow-MSCs (BM-MSC-EXOs) and iPSC-MSCs (iPSC-MSC-EXOs) were collected and intramuscularly injected into the peri-infarct region of a mouse MI model. Cardiac function was assessed four weeks post-injection. Myocardial pyroptosis was evaluated using TUNEL staining and measurement of associated factors. Neonatal mouse cardiomyocytes (NMCMs) exposed to serum deprivation and hypoxia (SD/H) were treated with BM-MSC-EXOs or iPSC-MSC-EXOs. A loss-of-function approach was employed to examine the role of iPSC-MSC-exosomal-miR-202-5p in regulating cardiomyocyte pyroptosis. Compared to BM-MSC-EXOs, iPSC-MSC-EXOs demonstrated superior improvement in cardiac function in MI mice. Both BM-MSC-EXOs and iPSC-MSC-EXOs reduced cardiomyocyte pyroptosis by downregulating proteins NLRP3, ASC, Caspase-1, and gasdermin D-NT, as well as inflammatory factors in MI mice and SD/H-treated NMCMs. iPSC-MSC-EXOs exhibited greater protective effects. MicroRNA sequencing revealed higher levels of miR-202-5p in iPSC-MSC-EXOs than in BM-MSC-EXOs. The protective effect of iPSC-MSC-EXOs against cardiomyocyte pyroptosis was partially reversed by miR-202-5p knockdown. Mechanistically, miR-202-5p in iPSC-MSC-EXOs inhibited cardiomyocyte pyroptosis by downregulating the TRAF3IP2/JNK pathway. iPSC-MSC-EXOs protect against MI by inhibiting cardiomyocyte pyroptosis via miR-202-5p-mediated suppression of the TRAF3IP2/JNK axis. These findings suggest a promising therapeutic approach for MI.

Targeted cardiac screening of athletes

2025-06-02

Erik Ekker Solberg , Charlotte B. Ingul , Thor Edvardsen +7 more | Tidsskrift for Den norske legeforening

Extreme phenotypes of the female athlete’s heart: a sports-specific cardiac magnetic resonance imaging study

2025-06-02

J C Van Hattum , M A Van Diepen , Sjoerd M Verwijs +7 more | European Heart Journal - Cardiovascular Imaging

Abstract Aims Differentiating physiological exercise-induced cardiac remodelling (EICR) from pathology is challenging, especially in female athletes, where studies using state-of-the-art imaging techniques are lacking. We aimed to investigate extreme phenotypes … Abstract Aims Differentiating physiological exercise-induced cardiac remodelling (EICR) from pathology is challenging, especially in female athletes, where studies using state-of-the-art imaging techniques are lacking. We aimed to investigate extreme phenotypes of EICR in female elite athletes using magnetic resonance imaging (MRI). Methods and results Cross-sectional, multicentre study in female elite athletes using contrast-enhanced cardiac MRI. Left and right ventricle (LV, RV) indices and LV mass (LVM)-to-LV end-diastolic volume (EDV) ratios were investigated, indexed by body surface area (BSA). Cardiac remodelling was determined comparing cardiac MRI metrics to female reference values, stratified by ESC sports classification (endurance, mixed, power/skill). In 173 female elite athletes (median age 25 years, median 18 h training/week, 97% Caucasian), mean LV EDV/BSA and LVM/BSA were 108 ± 13 mL/m2 and 50 ± 10 g/m2, with lower LVM/LV EDV ratios (0.5 ± 0.1) than the general population (0.7 ± 0.1 g/mL; P &lt; 0.001). Most athletes (71%) had isolated LV EDV increases; LVM increases (18%) commonly coincided with LV EDV increases. Compared with the general population (45 ± 7 g/m2), only mixed (48 ± 9 g/m2; P = 0.021) and endurance athletes (53 ± 11 g/m2; P &lt; 0.001) exhibited greater mean LVM with endurance athletes surpassing mixed athletes (P = 0.004). Mixed and endurance showed comparably greater median biventricular EDV compared with power/skill athletes [LV: 109 (103–119) and 111 (101–118) vs. 99 (92–105); RV: 110 (103–118) and 112 (105–124) vs. 101 (95–104) mL/m2; P &lt; 0.001]. Maximum wall thickness &gt; 11 mm was rare (2%). Global T1 time was 968 ± 22 ms; extracellular volume was 25 ± 4%. Conclusion Female elite athletes, particularly endurance-trained athletes, display EICR marked by increased ventricular volumes, without prominent increases in LVM or wall thickness. Trial Registration Number NL9328

Proteomic Insights into Cardiometabolic Remodeling in SARS-CoV-2-Infected Hamsters

2025-06-01

Sogol Sedighi , Ting Liu , Deepthi Ashok +5 more | Journal of Molecular and Cellular Cardiology Plus

Value of molecular autopsy in suspected sudden cardiac death in the young

2025-06-01

Mònica Coll , Mireia Alcalde , Anna Fernández-Falgueras +7 more | Journal of Molecular Diagnostics

COMMENTARY: SUDDEN DEATH IN COMPETITIVE STUDENT- ATHLETES WITH HYPERTROPHIC CARDIOMYOPATHY AT A CROSSROADS: CRITICAL VIEWS ON LIBERALIZING RETURN-TO-PLAY ELIGIBILITY

2025-06-01

Barry J. Maron , Ethan J. Rowin , Jiří Bonaventura +7 more | Heart Rhythm