Background: To assess the event rates of myocarditis detected by Cardiac Magnetic Resonance (CMR) in athletes who recovered from COVID-19. Methods: A systematic literature search was performed to identify studies reporting abnormal CMR findings in athletes who recovered from COVID-19. Secondary analyses were performed considering increased serum high sensitivity troponin (hs-Tn) levels and electrocardiographic (ECG) and echocardiographic (ECHO) abnormalities. Results: In total, 7988 athletes from 15 studies were included in the analysis. The pooled event rate of myocarditis was 1% (CI 1–2%), reaching 4% in the sub-group analysis. In addition, heterogeneity was observed (I2 43.8%). The pooled event rates of elevated serum hs-Tn levels, abnormal ECG and ECHO findings were 2% (CI 1–5%), 3% (CI 1–10%) and 2% (CI 1–6%), respectively. ECG, ECHO and serum hs-Tn level abnormalities did not show any correlation with myocarditis. Conclusions: The prevalence of COVID-19-related myocarditis in the athletic population ranges from 1 to 4%. Even if the event rate is quite low, current screening protocols are helpful tools for a safe return to play to properly address CMR studies. Trial registration: the study protocol was registered in the PROSPERO database (registration number: CRD42022300819).
Total word count: 4862 24 This research did not receive any specific grant from funding agencies in the public, commercial, 25 or non-profit sectors. 26 2 The authors have no conflicts to disclose. Abstract 41 Background. Ventricular tachyarrhythmias (VA) represent the first cause of death in athletes. The 42 difference between electroanatomic substrate in athletes and non-athletes with complex VA is 43 unknown. 44 45 Objective. To compare the electroanatomic substrate of complex VA in athletes versus non-46 athletes. 47 48 Methods. We prospectively enrolled young athletes and non-athletes with VA. Patients underwent 49 2D echo, cardiac magnetic resonance (CMR), coronary angiography, 3D-electroanatomic mapping 50 (3D-EAM) and 3D-EAM guided endomyocardial biopsy (EMB). Follow-up included 24h ECG 51 Holter or ICD/loop recorder interrogation for VA recurrence.52 53Results. We enrolled 33 consecutive patients, 18 (56%) competitive athletes and 15 (44%) non-54 athletes. Left and right ventricular (LV and RV) findings by echo and CMR did not show 55 structural disease. Nine (50%) athletes were asymptomatic compared to 1 (7%) non-athlete 56 (p<0.05). Unifocal origin of VA was reported in 14 (93%) athletes and in 17 (94%) non-athletes. 57Athletes showed a larger RV unipolar than bipolar scar (18 ± 17 cm 2 versus 3 ± 3.8 cm 2 , p= 0.04). 58 Diagnostic yield of EMB was 50% in athletes and 40% in non-athletes. Among athletes, the final 59 diagnosis was myocarditis in 2 cases, arrhythmogenic ventricular right cardiomyopathy and focal 60 replacement fibrosis in one case each. Among non-athletes, EMB revealed focal replacement 61 fibrosis in 4 cases. At median follow-up of 18.7 months, Kaplan Meyer curves showed lower VA 62recurrence in detrained athletes than non-athletes (53% versus 6%, p= 0.02). 64Conclusions. Our data showed the need for an extensive diagnostic work-up in apparently healthy 65 young patients with complex VA in order to characterize concealed cardiomyopathies. 66 67 4
Among treatments proposed for idiopathic male infertility, antiestrogens, like tamoxifen, play a possible role. On the other hand, oxidative stress is a mechanism well recognized for deleterious effects on spermatozoa function. After reviewing the literature on the effects of estrogens in modulation of antioxidant systems, in both sexes, and in different in vivo and in vitro models, we suggest, also on the basis of personal data, that a tamoxifen treatment could be active via an increase in seminal antioxidants.
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