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Sports Cardiology: From Diagnosis to Clinical Management

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A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Epidemiology, Lifestyle, and Cardiovascular Health".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 20487

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Special Issue Editors

Dr. Stavros Dimopoulos

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Guest Editor

1. Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, 106 75 Athens, Greece
2. Cardiac Surgery ICU, Onassis Cardiac Surgery Center, 176 74 Athens, Greece
Interests: exercise training; rehabilitation; cardiopulmonary exercise testing; critical illness; heart failure; pulmonary hypertension; cardiac surgery; extracorporeal membrane oxygenation (ECMO)
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Dr. Christos Kourek

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1. Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, 106 75 Athens, Greece
2. Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), 115 21 Athens, Greece
Interests: heart failure; endothelial progenitor cells; endothelium; myocardial infarction; revascularization; cardiopulmonary resuscitation; myocarditis; cardiopulmonary exercise testing; exercise training; rehabilitation
Special Issues, Collections and Topics in MDPI journals

Dr. Eleftherios Karatzanos

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Guest Editor

Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, 106 75 Athens, Greece
Interests: heart failure; endothelial progenitor cells; cardiopulmonary exercise testing; exercise training; rehabilitation; acute exercise; neuromuscular electrical stimulation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Cardiovascular Development and Disease focusses on sports cardiology, and specifically on exercise recommendations and eligibility criteria for sports participation in competitive athletes with cardiovascular disease and for exercise training programmes in subjects with known or previously undiagnosed cardiovascular disease. During the last several decades, more and more people all over the world are being diagnosed with coronary artery heart syndromes, heart failure, valvular heart disease, peripheral vascular disease, congenital heart disease, aortopathies and cardiomyopathies, while others face lethal arrhythmias and sudden cardiac death due to misdiagnosis or underdiagnosis. New diagnostic methods have contributed to the early diagnosis and risk stratification of cardiovascular disease. Regular physical activity, including structured exercise training programmes is an important component of treatment strategies for stable cardiovascular disease, and is associated with favourable outcomes including improved quality of life and reduced cardiovascular and all-cause mortality. The process from the diagnosis of cardiovascular disease until patients’ participation in exercise training programmes is of paramount importance to achieve optimal outcome. However, this is a complex procedure, including a multidisciplinary approach and several stages such as screening, diagnosis, risk stratification, shared decision making with physicians and secondary prevention and treatment through exercise protocols, defining the appropriate duration and intensity individualized for each patient.

We are pleased to invite authors to submit original research articles, recommendation articles, and reviews covering all aspects of sports cardiology, from diagnosis to clinical management. In order to evaluate and organize the content of the Special Issue, please let us know the preliminary title of your paper, the type of paper that you plan to submit (research article, review or case report) and any other additional information that would be useful. All manuscripts of original research that fit the scope of this Special Issue are welcome. For reviews, a direct co-operation between the authors and the Guest Editors would be useful to avoid thematic overlaps.

Participation in this Special Issue through the submission of a manuscript could be an excellent opportunity for primary researchers to enrich their CV, for doctoral or post-doctoral trainees to gain experience in writing reviews in Sports Cardiology and for institutions to present their original research in a high-quality journal.

Dr. Stavros Dimopoulos
Dr. Christos Kourek
Dr. Eleftherios Karatzanos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

sports cardiology
cardiovascular risk factors
diabetes mellitus
arterial hypertension
obesity
diagnosis
chronic coronary syndromes
coronary artery bypass graft surgery
heart failure
valvular heart disease
pulmonary hypertension
congenital heart disease
cardiomyopathies
ventricular assist devices
sudden cardiac death
exercise training
rehabilitation
risk stratification

Related Special Issue

Sports Cardiology: From Diagnosis to Clinical Management, 2nd Edition in Journal of Cardiovascular Development and Disease

Published Papers (8 papers)

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Research

Jump to: Review

10 pages, 483 KiB

Open AccessArticle

Speckle-Tracking Analysis of the Right and Left Heart after Peak Exercise in Healthy Subjects with Type 1 Diabetes: An Explorative Analysis of the AppEx Trial

by Paul Zimmermann, Janis Schierbauer, Niklas Kopf, Harald Sourij, Nick Oliver, Felix Aberer, Nadine B. Wachsmuth and Othmar Moser

J. Cardiovasc. Dev. Dis. 2023, 10(11), 467; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10110467 - 17 Nov 2023

Viewed by 1298

Abstract

In eight healthy participants with Type 1 diabetes (T1D) exercise-related dynamic cardiac remodeling was analyzed by performing two-dimensional echocardiography, including deformation analysis of the left-ventricular (LV) global longitudinal strain (LV-GLS), and the deformation pattern of the left atrium (LA) and right ventricle (RV) at rest and post-peak performance on a bicycle. The feasibility echocardiographic speckle-tracking analysis was performed on eight asymptomatic participants with T1D (n = 8, male n = 5, age: 23–65 years). The obtained echocardiographic data were compared for various echocardiographic parameters at rest and post exercise. Across our participating T1D individuals no structural echocardiographic abnormalities of concern could be revealed. All participating T1D subjects showed preserved contractile reserve of the LV and no significant diastolic dysfunction. Significant differences were found for the phasic LA contractile strain pattern at rest and post exercise (p < 0.001), whereby the dynamic RV (p = 0.5839 and p = 0.7419) and LV strain pattern (p = 0.5952) did not reveal significant differences in comparison to resting conditions. This descriptive secondary outcome analysis describes preserved contractile reserve of the LV and elucidates dynamic modification of the phasic LA contractile deformation pattern in asymptomatic T1D individuals after exhaustive exercise on a bicycle. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

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11 pages, 536 KiB

Open AccessArticle

Preparticipation Screening of Athletes: The Prevalence of Positive Family History

by Bogna Jiravska Godula, Otakar Jiravsky, Petra Pesova, Libor Jelinek, Marketa Sovova, Katarina Moravcova, Jaromir Ozana, Miroslav Hudec, Roman Miklik, Jan Hecko, Libor Sknouril and Eliska Sovova

J. Cardiovasc. Dev. Dis. 2023, 10(4), 183; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10040183 - 21 Apr 2023

Cited by 2 | Viewed by 2121

Abstract

Sudden cardiac death (SCD) is a leading cause of death among athletes, and those with a positive family history (FH) of SCD and/or cardiovascular disease (CVD) may be at increased risk. The primary objective of this study was to assess the prevalence and predictors of positive FH of SCD and CVD in athletes using four widely used preparticipation screening (PPS) systems. The secondary objective was to compare the functionality of the screening systems. In a cohort of 13,876 athletes, 1.28% had a positive FH in at least one PPS system. Multivariate logistic regression analysis identified the maximum heart rate as significantly associated with positive FH (OR = 1.042, 95% CI = 1.027–1.056, p < 0.001). The highest prevalence of positive FH was found using the PPE-4 system (1.20%), followed by FIFA, AHA, and IOC systems (1.11%, 0.89%, and 0.71%, respectively). In conclusion, the prevalence of positive FH for SCD and CVD in Czech athletes was found to be 1.28%. Furthermore, positive FH was associated with a higher maximum heart rate at the peak of the exercise test. The findings of this study revealed significant differences in detection rates between PPS protocols, so further research is needed to determine the optimal method of FH collection. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

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10 pages, 394 KiB

Open AccessArticle

Long-Term Results of Serial Exercise Testing and Echocardiography Examinations in Patients with Pulmonary Stenosis

by Chia-Hsin Yang, Li-Yun Teng, Ming-Wei Lai, Ken-Pen Weng, Sen-Wei Tsai and Ko-Long Lin

J. Cardiovasc. Dev. Dis. 2023, 10(1), 31; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10010031 - 16 Jan 2023

Viewed by 1815

Abstract

Pulmonary stenosis (PS) affects cardiopulmonary function and exercise performance. Cardiopulmonary exercise testing (CPET) together with transthoracic echocardiography (TTE) can measure exercise performance, PS progression, and treatment effects. We assessed exercise capacity in PS patients using these methods. We enrolled 28 PS patients aged 6–35 years who received surgery, balloon pulmonary valvuloplasty, and follow-up care. The control population was selected by a 1:1 matching on age, sex, and body mass index. Baseline and follow-up peak pulmonary artery pulse wave velocity (PAV) were compared using TTE. Initial CPET revealed no significant differences in anaerobic metabolic equivalent (MET), peak oxygen consumption (VO₂), and heart rate recovery between the two groups, nor were significant differences in pulmonary function identified. Within the PS group, there were no significant differences in MET, peak VO₂, and heart rate recovery between the baseline and final CPET. Similarly, no significant differences were observed between the baseline and final PAV. The exercise capacity of patients with properly managed PS was comparable to that of healthy individuals. However, during the follow-up, declining trends in pulmonary function, aerobic metabolism, and peak exercise load capacity were observed among adolescents with PS. This study provides long-term data suggesting that PS patients should be encouraged to perform physical activity. Regular reevaluation should also be encouraged to limit performance deterioration. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

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11 pages, 277 KiB

Open AccessArticle

Left Ventricular Diastolic Response to Isometric Handgrip Exercise in Physically Active and Sedentary Individuals

by Dimitrios Rovithis, Maria Anifanti, Nikolaos Koutlianos, Andriana Teloudi, Evangelia Kouidi and Asterios Deligiannis

J. Cardiovasc. Dev. Dis. 2022, 9(11), 389; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9110389 - 11 Nov 2022

Viewed by 1147

Abstract

Aims: This study aims to investigate the diastolic left ventricular (LV) response to isometric handgrip exercise among healthy middle-aged men with high physical activity levels, versus matched sedentary individuals. Methods: Two groups of 10 men aged 41–51 years were studied. Men in the first group had high weekly self-reported physical activity levels (>3000 METs × min/week). In comparison, men in the second group reported low physical activity levels (<300 METs × min/week). An isometric handgrip exercise (IHE) stress echocardiography test was performed in all of them. Results: Both groups showed a similar and statistically significant increase in heart rate, systolic, diastolic, and mean arterial pressure following IHE. The group of active men under study did not show a statistically significant change in the ratio of early diastolic mitral valve inflow velocity to early diastolic lateral wall tissue velocity (E/e’ ratio) in response to IHE. Conversely, the inactive participants’ E/e’ ratio was higher at peak activity in the isometric handgrip exercise. Conclusions: Apparently, healthy middle-aged men with high levels of physical activity seem to have an improved lusitropic cardiac function compared to men with low levels of physical activity, as observed by the different diastolic LV responses induced by isometric handgrip exercise. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

11 pages, 772 KiB

Open AccessArticle

Ankle-Brachial Index and Arterial Stiffness, Modulate the Exertional Capacity of High-Frequency Training Athletes

by Raffaello Pellegrino, Eleonora Sparvieri, Andrea Di Blasio, Giovanni Barassi, Massimiliano Murgia, Patrizio Ripari and Angelo Di Iorio

J. Cardiovasc. Dev. Dis. 2022, 9(9), 312; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9090312 - 19 Sep 2022

Cited by 1 | Viewed by 1589

Abstract

Ankle-brachial index and arterial stiffness are associated with leg function in the elderly and in patients with peripheral arterial disease. Little is known about the meaning of these parameters in young and trained subjects and how they are related to physical performance. The main objective was to evaluate the mediating role of arterial stiffness and ankle-brachial index in physical performance. In a cross-sectional, case-control study, 240 male athletes were consecutively enrolled from the Laboratory of Cardiology and Sports Medicine, “G. d’Annunzio” University (Italy). All the subjects underwent the examination protocol for the annual medical evaluation for sport participation. Soccer (football) players compared to runners showed a lower level of ankle-brachial index, higher arterial stiffness, and lower systolic and diastolic blood pressure. In the treadmill stress test, soccer players compared to runners showed a greater maximal aerobic capacity. Differences in cardiovascular performance between soccer players and runners were mediated by better arterial stiffness and low level of ankle-brachial index; the estimated effect was 0.11 ± 0.05 and 0.24 ± 0.06, respectively. Vigorous strength training drops blood pressure and increases arterial stiffness. Taken together, our findings would seem to suggest that ABI and CAVI could be used as markers for athletes’ performance. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

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Review

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18 pages, 691 KiB

Open AccessEditor’s ChoiceReview

SCUBA Diving in Adult Congenital Heart Disease

by Robert M. Kauling, Rienk Rienks, Judith A. A. E. Cuypers, Harald T. Jorstad and Jolien W. Roos-Hesselink

J. Cardiovasc. Dev. Dis. 2023, 10(1), 20; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10010020 - 04 Jan 2023

Cited by 2 | Viewed by 2755

Abstract

Conventionally, scuba diving has been discouraged for adult patients with congenital heart disease (ACHD). This restrictive sports advice is based on expert opinion in the absence of high-quality diving-specific studies. However, as survival and quality of life in congenital heart disease (CHD) patients have dramatically improved in the last decades, a critical appraisal whether such restrictive sports advice is still applicable is warranted. In this review, the cardiovascular effects of diving are described and a framework for the work-up for ACHD patients wishing to engage in scuba diving is provided. In addition, diving recommendations for specific CHD diagnostic groups are proposed. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

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21 pages, 1356 KiB

Open AccessReview

Exercise Training Effects on Circulating Endothelial and Progenitor Cells in Heart Failure

by Christos Kourek, Alexandros Briasoulis, Virginia Zouganeli, Eleftherios Karatzanos, Serafim Nanas and Stavros Dimopoulos

J. Cardiovasc. Dev. Dis. 2022, 9(7), 222; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9070222 - 10 Jul 2022

Cited by 10 | Viewed by 2379

Abstract

Heart failure (HF) is a major public health issue worldwide with increased prevalence and a high number of hospitalizations. Patients with chronic HF and either reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF) present vascular endothelial dysfunction and significantly decreased circulating levels of endothelial progenitor cells (EPCs). EPCs are bone marrow-derived cells involved in endothelium regeneration, homeostasis, and neovascularization. One of the unsolved issues in the field of EPCs is the lack of an established method of identification. The most widely approved method is the use of monoclonal antibodies and fluorescence-activated cell sorting (FACS) analysis via flow cytometry. The most frequently used markers are CD34, VEGFR-2, CD45, CD31, CD144, and CD146. Exercise training has demonstrated beneficial effects on EPCs by increasing their number in peripheral circulation and improving their functional capacities in patients with HFrEF or HFmrEF. There are two potential mechanisms of EPCs mobilization: shear stress and the hypoxic/ischemic stimulus. The combination of both leads to the release of EPCs in circulation promoting their repairment properties on the vascular endothelium barrier. EPCs are important therapeutic targets and one of the most promising fields in heart failure and, therefore, individualized exercise training programs should be developed in rehabilitation centers. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

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29 pages, 710 KiB

Open AccessEditor’s ChoiceReview

Modalities of Exercise Training in Patients with Extracorporeal Membrane Oxygenation Support

by Christos Kourek, Serafim Nanas, Anastasia Kotanidou, Vasiliki Raidou, Maria Dimopoulou, Stamatis Adamopoulos, Andreas Karabinis and Stavros Dimopoulos

J. Cardiovasc. Dev. Dis. 2022, 9(2), 34; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9020034 - 20 Jan 2022

Cited by 8 | Viewed by 5691

Abstract

The aim of this qualitative systematic review is to summarize and analyze the different modalities of exercise training and its potential effects in patients on extracorporeal membrane oxygenation (ECMO) support. ECMO is an outbreaking, life-saving technology of the last decades which is being used as a gold standard treatment in patients with severe cardiac, respiratory or combined cardiorespiratory failure. Critically ill patients on ECMO very often present intensive care unit-acquired weakness (ICU-AW); thus, leading to decreased exercise capacity and increased mortality rates. Early mobilization and physical therapy have been proven to be safe and feasible in critically ill patients on ECMO, either as a bridge to lung/heart transplantation or as a bridge to recovery. Rehabilitation has beneficial effects from the early stages in the ICU, resulting in the prevention of ICU-AW, and a decrease in episodes of delirium, the duration of mechanical ventilation, ICU and hospital length of stay, and mortality rates. It also improves functional ability, exercise capacity, and quality of life. Rehabilitation requires a very careful, multi-disciplinary approach from a highly specialized team from different specialties. Initial risk assessment and screening, with appropriate physical therapy planning and exercise monitoring in patients receiving ECMO therapy are crucial factors for achieving treatment goals. However, more randomized controlled trials are required in order to establish more appropriate individualized exercise training protocols. Full article

(This article belongs to the Special Issue Sports Cardiology: From Diagnosis to Clinical Management)

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