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Exercise and Sports Cardiology

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 25 July 2024 | Viewed by 11352

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Dr. Michela Casella

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Guest Editor

1. Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", 60126 Ancona, Italy
2. Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, 60126 Ancona, Italy
Interests: cardiac arrhythmia; atrial fibrillation

Special Issue Information

Dear Colleagues,

In recent years, there has been a growing awareness that physical sports activity is essential to achieve a state of mental and physical well-being, to prevent major chronic diseases, and to counteract aging processes. In this scenario, cardiology plays a primary role, and its fields of application are many: cardiovascular assessment in the healthy patient or in the patient with chronic diseases; the effect of training on the cardiovascular system (consider the so-called athlete's heart); the prevention and treatment of sudden cardiac death related to physical exertion, etc. In addition, there are many points of contact with emerging fields of medicine such as genetics, epigenetics, gender medicine and, finally, artificial intelligence.

This Special Issue (SI) of the Journal of Clinical Medicine, entitled “Exercise and Sports Cardiology”, focuses on the most clinically innovative advances and applications in imaging, interventional cardiology, rehabilitation, and basic research that address the complex relationship between cardiology and sports physical activity. The goal is to publish ground-breaking research articles of significant clinical and scientific value, including observational studies, clinical trials, and review articles. Unique clinical cases, particularly supported by advanced imaging, will also be welcome.

We anticipate that the success of exercise and sports cardiology will lead to the publication of other SI in different cardiology subspecialties.

Dr. Michela Casella
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 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

cardiology research
cardiovascular disease
sudden cardiac death
coronary artery disease
myocardial disease
heart failure
preventive cardiology
ventricular arrhythmias
cardiac imaging
physical activity
sports eligibility assessment
atherosclerosis

Published Papers (9 papers)

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Research

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15 pages, 1165 KiB

Open AccessArticle

Idiopathic Premature Ventricular Contraction Catheter Ablation, Sedentary Population vs. Athlete’s Populations: Outcomes and Resumption of Sports Activity

by Yari Valeri, Paolo Compagnucci, Giovanni Volpato, Lara Luciani, Eleonora Crepaldi, Francesco Maiorino, Quintino Parisi, Laura Cipolletta, Francesca Campanelli, Leonardo D’Angelo, Gemma Gaggiotti, Alessio Gasperetti, Andrea Giovagnoni, Antonio Curcio, Antonio Dello Russo and Michela Casella

J. Clin. Med. 2024, 13(7), 1871; https://doi.org/10.3390/jcm13071871 - 24 Mar 2024

Viewed by 465

Abstract

There are no investigations about the outcomes of idiopathic PVC catheter ablation (CA) in athletes compared to the sedentary population. We conducted a prospective single-centre observational study. The primary and secondary procedural outcomes were the post-ablation reduction of premature ventricular contractions (PVCs) in an athletes vs. non-athletes group and in agonist vs. leisure-time athletes. The third was the evaluation of the resumption of physical activity and the improvement of symptoms in agonist and leisure-time athletes. From January 2020 to October 2022 we enrolled 79 patients with RVOT/LVOT/fascicular PVC presumed origin. The median percentage of decrease between the pre-procedure and post-procedure Holter monitoring in the non-athletes group was 96 (IQR 68–98) and 98 in the athletes group (IQR 92–99) (p = 0.08). Considering the athletes, the median percentage of decrease in the number of PVCs was 98 (IQR 93–99) and 98 (IQR 87–99), respectively, in leisure-time and agonistic athletes (p = 0.42). Sixteen (70%) leisure time and seventeen (90%) agonist athletes (p = 0.24) have resumed physical activity 3 months after PVC CA; among agonistic athletes, 59% have resumed competitive physical activity. Many leisure-time (88%) and agonist (70%) athletes experienced an improvement in symptoms after ablation. PVC CA was effective and safe in both groups, reducing symptoms and allowing a quick and safe return to sports activities in athletes. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

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13 pages, 1158 KiB

Open AccessArticle

Long-Term Functional Limitations on Cardiopulmonary Exercise Testing in Emotion-Triggered Takotsubo Syndrome

by Jean Pierre Jabbour, Luca Arcari, Luca Cacciotti, Damiano Magrì, Tommaso Recchioni, Livia Valeri, Enrico Maggio, Carmine Dario Vizza, Roberto Badagliacca and Silvia Papa

J. Clin. Med. 2024, 13(4), 1163; https://doi.org/10.3390/jcm13041163 - 19 Feb 2024

Viewed by 548

Abstract

Background: In patients with prior Takotsubo syndrome (TTS), long-lasting functional cardiac limitations were described as compared with normal subjects. Emotion-triggered Takotsubo syndrome (E-TTS) has more favorable outcomes than TTS preceded by a physical trigger or by no identifiable factors. The aim of the present study was to assess long-term cardiac functional limitations in a cohort of asymptomatic E-TTS patients. Methods: We enrolled n = 40 asymptomatic patients with a diagnosis of E-TTS. Cardiopulmonary exercise tests (CPET) were performed at 30 (12–40) months median follow-up from the acute event. A cohort of n = 40 individuals matched for age, sex, body mass index and comorbidities served as control. Results: Despite recovery of left ventricular ejection fraction, patients with prior E-TTS had lower peak VO₂ and percentage of predicted peak VO₂ (17.8 ± 3.6 vs. 22.1 ± 6.5; p < 0.001 and 75.2 ± 14.1% vs. 100.6 ± 17.1%, p < 0.001), VO₂ at anaerobic threshold (AT) (11.5 [10.1–12.9] vs. 14.4 [12.5–18.7]; p < 0.001), peak O₂ pulse (9.8 ± 2.5 vs. 12.9 ± 3.5; p < 0.001) and higher VE/VCO2 slope (30.5 ± 3.7 vs. 27.3 ± 3.5; p < 0.001) compared with matched controls. We found no statistically significant differences in heart rate reserve (HRR), respiratory equivalent ratio (RER), mean blood pressure and peak PetCO₂ between patients and controls. Conclusions: Despite its favorable outcome, patients with E-TTS in our population were found to have subclinical long-term functional cardiac limitations as compared with a control cohort. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

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10 pages, 211 KiB

Open AccessArticle

The Impact of Medical Face Masks and Rehabilitation Duration on the Performance Output and Outcomes of Cardiologic Rehabilitants

by Nils Klophaus, Udo F. Wehmeier, Julia Forstner, Armin Jansen, Herbert Probst, Stephan Grüter and Thomas Hilberg

J. Clin. Med. 2024, 13(4), 1086; https://doi.org/10.3390/jcm13041086 - 14 Feb 2024

Viewed by 510

Abstract

During the COVID-19 pandemic, wearing a medical face mask became mandatory in daily life and also in cardiological rehabilitation. In order to investigate whether the performance and outcomes of cardiological rehabilitation were affected by face masks, we compared data from patients who underwent rehabilitation with face masks with data from patients without face masks. In total, 114 patients from an ambulant rehabilitation center were included. Of them, 60 patients completed rehabilitation without a face mask (NFM). In contrast, 54 patients (with a face mask, WFM) completed their rehabilitation during the COVID-19 pandemic and had to wear medical face masks for the entire day and also during ergometer training or other interventions. Subgroups were formed with patients who accepted to extend rehabilitation for one week (4 WG); the other patients only completed 3-week rehabilitation (3 WG). We analyzed the performance and outcomes of all groups (NFM; WFM, 3 WG and 4 WG). At baseline, no group differences were detected. All groups significantly improved their power output and heart rate recovery, without any group differences. We conclude that face masks and also an additional rehabilitation week do not affect the exercise performance or outcomes of out-house cardiological rehabilitation. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

16 pages, 3275 KiB

Open AccessArticle

Cardiological Functional Assessment of National Olympic Team of Kazakhstan

by Dauren Yerezhepov, Aidana Gabdulkayum, Galiya Bilyalova, Saya Amangeldikyzy, Ulan A. Kozhamkulov, Saule E. Rakhimova, Ulykbek Y. Kairov and Ainur Akilzhanova

J. Clin. Med. 2023, 12(24), 7511; https://doi.org/10.3390/jcm12247511 - 05 Dec 2023

Viewed by 684

Abstract

Athletes carry an increased risk of cardiovascular (CV) conditions. Due to the relatively high loads and intensity of the training process, athletes’ CV systems undergo various adaptations, which can combine in the future and provoke unexpected outcomes. Most CV screening protocols have several successive steps. The aim of our study was to perform a cardiological functional assessment of the National Olympic Team of Kazakhstan via several noninvasive protocols to close the gaps between the approaches and collect solid data for the prevention of sudden cardiac death (SCD) incidence among Kazakhstani athletes. Methods: The methods used in this study were 12-lead resting electrocardiography (ECG), echocardiography, cardiointervalography, cardiopulmonary exercise testing (CPET), and HyperQ stress testing. Results: One case was detected via 12-lead resting ECG. Another case of the slowdown of the heart rate (HR) recovery was detected via cardiointervalography with no clinical signs and normal ECG. The HyperQ stress testing of the women’s basketball team detected a positive result in four leads in one athlete. Conclusion: Our results demonstrate that the CV systems of athletes require the implementation of several diagnostic methods in rest and stress conditions for more precise evaluation, with each of the methods fulfilling the whole picture for the prevention of such tragic events as sudden cardiac death and sudden cardiac arrest. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

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14 pages, 550 KiB

Open AccessArticle

Lipid Profile in Olympic Athletes: Proposal for a “Lipid Athlete Score” as a Clinical Tool to Identify High-Risk Athletes

by Giuseppe Di Gioia, Lorenzo Buzzelli, Viviana Maestrini, Antonio Nenna, Sara Monosilio, Maria Rosaria Squeo, Erika Lemme and Antonio Pelliccia

J. Clin. Med. 2023, 12(23), 7449; https://doi.org/10.3390/jcm12237449 - 30 Nov 2023

Viewed by 828

Abstract

Dyslipidemia is a major risk factor for atherosclerosis. Identification of dyslipidemia in athletes has raised interest in establishing preventive strategies and reducing cardiovascular (CV) events. Nowadays, targets or “scores” for athletes are undefined. The aim of our study was to create a “Lipid Athlete Score” based on lipid parameters and derive score indexes to identify high-risk athletes. We retrospectively enrolled 957 Olympic athletes practicing different sporting disciplines (power, skills, endurance, and mixed), analyzing their CV profiles and anthropometrics; 55.4% were male, the mean age was 27.1 ± 5 years, and the mean body mass index (BMI) was 23.1 ± 3.2 kg/m². Three hundred and forty-three athletes (35.8%) were dyslipidemic (LDL ≥ 115 mg/dL or LDL/HDL ≥ 1.90). Multivariate analysis revealed the following: male p = 0.001, OR 1.88 [0.41–2.51], familiarity for dyslipidemia p = 0.001, OR 2.82 [1.72–4.59], BMI ≥ 30 kg/m² p = 0.001, OR 2.53 [1.46–4.38], and fat mass p = 0.001, OR 2.29 [1.38–3.80] were significant. Endurance athletes presented the lowest CV risk. We proposed a lipid athlete score including major (LDL ≥ 115 mg/dL and LDL/HDL ≥ 1.90) and minor criteria (male, BMI > 30 kg/m² or fat mass >22% for males and 32% for females, familiarity for dyslipidemia, and conventional CV risk factors). Twelve athletes (1.2%) were at high risk, 150 athletes (15.7%) at medium risk, 171 athletes (17.9%) at low risk, and 624 (65.2%) were at no risk. Dyslipidemia is very common in elite athletes. We have defined a specific lipid athlete score based on lipid parameters and derived score indexes for the stratification of risk. In accordance with this tool, a substantial proportion of athletes (16.9%) were at medium-to-high risk and need early preventive strategies to improve their lipid profiles and reduce the future development of atherosclerotic CV diseases. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

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12 pages, 488 KiB

Open AccessArticle

Validity of the Maximal Heart Rate Prediction Models among Runners and Cyclists

by Przemysław Seweryn Kasiak, Szczepan Wiecha, Igor Cieśliński, Tim Takken, Jacek Lach, Marcin Lewandowski, Marcin Barylski, Artur Mamcarz and Daniel Śliż

J. Clin. Med. 2023, 12(8), 2884; https://doi.org/10.3390/jcm12082884 - 14 Apr 2023

Cited by 2 | Viewed by 2567

Abstract

Maximal heart rate (HRmax) is a widely used measure of cardiorespiratory fitness. Prediction of HRmax is an alternative to cardiopulmonary exercise testing (CPET), but its accuracy among endurance athletes (EA) requires evaluation. This study aimed to externally validate HRmax prediction models in the EA independently for running and cycling CPET. A total of 4043 runners (age = 33.6 (8.1) years; 83.5% males; BMI = 23.7 (2.5) kg·m⁻²) and 1026 cyclists (age = 36.9 (9.0) years; 89.7% males; BMI = 24.0 (2.7) kg·m⁻²) underwent maximum CPET. Student t-test, mean absolute percentage error (MAPE), and root mean square error (RMSE) were applied to validate eight running and five cycling HRmax equations externally. HRmax was 184.6 (9.8) beats·min⁻¹ and 182.7 (10.3) beats·min⁻¹, respectively, for running and cycling, p = 0.001. Measured and predicted HRmax differed significantly (p = 0.001) for 9 of 13 (69.2%) models. HRmax was overestimated by eight (61.5%) and underestimated by five (38.5%) formulae. Overestimated HRmax amounted to 4.9 beats·min⁻¹ and underestimated HRmax was in the range up to 4.9 beats·min⁻¹. RMSE was 9.1–10.5. MAPE ranged to 4.7%. Prediction models allow for limited precision of HRmax estimation and present inaccuracies. HRmax was more often underestimated than overestimated. Predicted HRmax can be implemented for EA as a supplemental method, but CPET is the preferable method. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

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11 pages, 433 KiB

Open AccessArticle

Effects of Concurrent, Within-Session, Aerobic and Resistance Exercise Training on Functional Capacity and Muscle Performance in Elderly Male Patients with Chronic Heart Failure

by Maurizio Volterrani, Giuseppe Caminiti, Marco Alfonso Perrone, Anna Cerrito, Alessio Franchini, Vincenzo Manzi and Ferdinando Iellamo

J. Clin. Med. 2023, 12(3), 750; https://doi.org/10.3390/jcm12030750 - 17 Jan 2023

Cited by 7 | Viewed by 2406

Abstract

Background. The best format of exercise training (ET) in the setting of cardiac rehabilitation in patients with chronic heart failure (CHF) is still to be defined. Current guidelines recommend aerobic exercises, such as running and cycling, including some sessions per week of resistance exercise. Aim. The aim of this study was to address the effectiveness of a concurrent exercise training program utilizing a circuit of sequential endurance and resistance exercises on functional capacity and muscular strength in patients with CHF. Methods. Ninety-five consecutive male patients (age 63.1 ± 6 years) with CHF (EF < 40%) in NYHA functional class II/III, were randomly assigned on 1:1 basis to a 12-week aerobic continuous training (AT) or concurrent CT), aerobic + resistance, training (CT), three times a week, with each session lasting 80 min. We used high quality, specifically designed ergometers, connected with each other and governed by a central console, and managed by a single physiotherapist. Before and after training all patients performed a symptoms-limited exercise test on a treadmill and a 6-min walking test (6MWT). Patients in the CT group also performed resistance exercises of upper and lower body. Results. The 6MWT and exercise duration at ergometric test increased significantly in both AT and CT groups, with the increase being greater in CT group (p < 0.001; ES = 0.13; p < 0.01; ES = 0.07). Muscular strength increased significantly in the CT group, particularly in the lower body muscular districts (p < 0.001). Quality of life improved in both groups, with a significantly greater improvement in the CT group (p < 0.05). No side effects leading to discontinuation of training were observed. Conclusions. These findings indicate that concurrent, within-session training results in larger improvements in functional capacity, in addition to muscle performance, in patients with CHF, in comparison to single-mode aerobic training. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

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Review

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10 pages, 754 KiB

Open AccessReview

Detraining among Athletes—Is Withdrawal of Adaptive Cardiovascular Changes a Hint for the Differential Diagnosis of Physically Active People?

by Kinga Zujko-Kowalska, Karol Adam Kamiński and Łukasz Małek

J. Clin. Med. 2024, 13(8), 2343; https://doi.org/10.3390/jcm13082343 - 18 Apr 2024

Viewed by 423

Abstract

An athlete’s training aims to achieve the highest possible sports results by improving physical dispositions which lead to cardiac adaptive changes. The annual training cycle is divided into periods. The preparatory period begins with gradually increasing training intensity and volume until the competitive period occurs, when the athlete’s maximum performance is expected. Finally, the athlete enters a phase of loss of fitness, which is called detraining. Detraining is a time of resting both physically and mentally from the training regime and usually lasts about 4 weeks for endurance athletes. We collected data from much research on athletes’ detraining. According to these data, the earliest change after detraining seems to be a decrease in left ventricular wall thickness and left ventricular mass, followed by decreased performance parameters, diastolic diameter of the left ventricle and size of the left atrium. A reversal of adaptive changes affects the left heart chamber first, then the right atrium and, finally, the right ventricle. Training reduction is often proposed as a method of differentiating an athlete’s heart from cardiomyopathies. The aim of this study is to consider the diagnostic value of detraining in differentiating athletes’ hearts from cardiomyopathies. We suggest that detraining cannot be conclusive in differentiating the disease from adaptive changes. Although a withdrawal of the characteristic morphological, functional and electrocardiographic changes occurs in healthy athletes during detraining, it can also concern individuals with cardiomyopathies due to the lower expression of abnormal features after decreased training loads. Therefore, a quick diagnosis and individual assessments using imaging and genetic tests are essential to recommend a proper type of activity. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

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24 pages, 3267 KiB

Open AccessReview

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

by Paolo Compagnucci, Adelina Selimi, Laura Cipolletta, Giovanni Volpato, Alessio Gasperetti, Yari Valeri, Quintino Parisi, Antonio Curcio, Andrea Natale, Antonio Dello Russo and Michela Casella

J. Clin. Med. 2024, 13(5), 1350; https://doi.org/10.3390/jcm13051350 - 27 Feb 2024

Viewed by 2113

Abstract

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. Full article

(This article belongs to the Special Issue Exercise and Sports Cardiology)

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