Myocardial Inflammation, Sports Practice, and Sudden Cardiac Death: 2021 Update

Compagnucci, Paolo; Volpato, Giovanni; Falanga, Umberto; Cipolletta, Laura; Conti, Manuel; Grifoni, Gino; Ciliberti, Giuseppe; Stronati, Giulia; Fogante, Marco; Bergonti, Marco; Sommariva, Elena; Guerra, Federico; Giovagnoni, Andrea; Russo, Antonio Dello; Casella, Michela

doi:10.3390/medicina57030277

Cited by 13 publications

(7 citation statements)

References 61 publications

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“…Even for inflammation, supporting evidence is limited to isolated case reports [ 43 ]. However, inflammation may render the ventricular myocardium more vulnerable to VAs [ 44 ], and this pathophysiological pathway may be especially relevant in elite athletes, who are at risk of viral infections due to frequent international travels, outdoor training competitions, exposure to extreme climates, and exercising despite symptoms of common cold, which may all facilitate the development of myocarditis [ 45 , 46 ], especially in the COVID-19 era [ 47 ].…”

Section: Arrhythmogenesis In Mitral Valve Prolapse and Relationship W...mentioning

confidence: 99%

Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment

Compagnucci,

Selimi,

Cipolletta

et al. 2024

JCM

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Although mitral valve prolapse (MVP) is the most prevalent valvular abnormality in Western countries and generally carries a good prognosis, a small subset of patients is exposed to a significant risk of malignant ventricular arrhythmias (VAs) and sudden cardiac death (SCD), the so-called arrhythmic MVP (AMVP) syndrome. Recent work has emphasized phenotypical risk features of severe AMVP and clarified its pathophysiology. However, the appropriate assessment and risk stratification of patients with suspected AMVP remains a clinical conundrum, with the possibility of both overestimating and underestimating the risk of malignant VAs, with the inappropriate use of advanced imaging and invasive electrophysiology study on one hand, and the catastrophic occurrence of SCD on the other. Furthermore, the sports eligibility assessment of athletes with AMVP remains ill defined, especially in the grey zone of intermediate arrhythmic risk. The definition, epidemiology, pathophysiology, risk stratification, and treatment of AMVP are covered in the present review. Considering recent guidelines and expert consensus statements, we propose a comprehensive pathway to facilitate appropriate counseling concerning the practice of competitive/leisure-time sports, envisioning shared decision making and the multidisciplinary “sports heart team” evaluation of borderline cases. Our final aim is to encourage an active lifestyle without compromising patients’ safety.

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Section: Arrhythmogenesis In Mitral Valve Prolapse and Relationship W...mentioning

confidence: 99%

Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment

Compagnucci,

Selimi,

Cipolletta

et al. 2024

JCM

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“…An higher incidence of sport related SCD in case of myocarditis is documented[ 148 ], for the higher rate of life-threatening ventricular arrhythmias[ 150 ]. In acute form, echocardiography may show global LV dysfunction[ 151 ], wall motion abnormalities and pericardial effusions[ 15 , 152 , 153 ], an diffuse myocardial edema (increased wall thickness)[ 154 - 157 ]. In healed form, echocardiographic LV systolic dysfunction is found rarely because there is often small myocardial fibrosis, with undetectable scar at echocardiography[ 158 ]: Its evaluation still represent one of the bigger challenges of sport cardiology.…”

Section: Myocarditismentioning

confidence: 99%

Potential role of an athlete-focused echocardiogram in sports eligibility

Palermi

Serio

Vecchiato

et al. 2021

WJC

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Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone (“grey zone”) with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.

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“…The next challenge is to translate all the results in the field of exercise to the clinics. In particular it will be necessary to better clarify the definition of "intense/strenuous exercise" in patients, to be able to provide clear, and maybe patient-tailored, recommendation to balance between a good quality of life and the risk of sudden cardiac death (137,138).…”

Section: Role Of Exercise and Immune Response In Acmmentioning

confidence: 99%

Inflammation in the Pathogenesis of Arrhythmogenic Cardiomyopathy: Secondary Event or Active Driver?

Meraviglia

Alcalde

Campuzano

et al. 2021

Front. Cardiovasc. Med.

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Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiac disease characterized by arrhythmia and progressive fibro-fatty replacement of the myocardium, which leads to heart failure and sudden cardiac death. Inflammation contributes to disease progression, and it is characterized by inflammatory cell infiltrates in the damaged myocardium and inflammatory mediators in the blood of ACM patients. However, the molecular basis of inflammatory process in ACM remains under investigated and it is unclear whether inflammation is a primary event leading to arrhythmia and myocardial damage or it is a secondary response triggered by cardiomyocyte death. Here, we provide an overview of the proposed players and triggers involved in inflammation in ACM, focusing on those studied using in vivo and in vitro models. Deepening current knowledge of inflammation-related mechanisms in ACM could help identifying novel therapeutic perspectives, such as anti-inflammatory therapy.

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Myocardial Inflammation, Sports Practice, and Sudden Cardiac Death: 2021 Update

Cited by 13 publications

References 61 publications

Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment

Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment

Potential role of an athlete-focused echocardiogram in sports eligibility

Inflammation in the Pathogenesis of Arrhythmogenic Cardiomyopathy: Secondary Event or Active Driver?

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