Author + information
- Received September 25, 2018
- Revision received December 10, 2018
- Accepted January 5, 2019
- Published online February 3, 2020.
- Christian Eichhorn, MBBS, BSca,
- Loïc Bière, MD, PhDa,b,c,
- Frédéric Schnell, MD, PhDd,
- Christian Schmied, MDe,
- Matthias Wilhelm, MDf,
- Raymond Y. Kwong, MD, MPHa and
- Christoph Gräni, MD, PhDa,f,g,∗ ()
- aNoninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
- bInstitut MitoVasc, Laboratoire Cardioprotection, Remodelage et Thrombose, University of Angers, Angers, France
- cDepartment of Cardiology, University Hospital of Angers, Angers, France
- dRennes University Health Centre, Sports Medicine Division, Physiology Laboratories, Rennes-1 University, Rennes, France
- eDepartment of Cardiology, University Heart Center, Zurich, Switzerland
- fDepartment of Cardiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland
- gCardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- ↵∗Address for correspondence:
Dr. Christoph Gräni, Department of Cardiology, Cardiac Imaging, Swiss Cardiovascular Center, University Hospital Berne, Freiburgstrasse, CH-3010 Berne, Switzerland.
• Myocarditis is a leading cause of SCD in athletes but diagnosis and risk stratification is challenging.
• Using latest data and existing recommendations, we present a new proposed diagnostic flowchart.
• Cardiac magnetic resonance imaging can diagnose but may also risk stratify athletes with suspected myocarditis.
• Sports behavior counseling may be guided by combining novel noninvasive and invasive tissue characterization methods
Presentation of myocarditis in athletes is heterogeneous and establishing the diagnosis is challenging with no current uniform clinical gold standard. The combined information from symptoms, electrocardiography, laboratory testing, echocardiography, cardiac magnetic resonance imaging, and in certain cases endomyocardial biopsy helps to establish the diagnosis. Most patients with myocarditis recover spontaneously; however, athletes may be at higher risk of adverse cardiac events. Based on scarce evidence and mainly autopsy studies and expert’s opinions, current recommendations generally advise abstinence from competitive sports ranging from a minimum of 3 to 6 months. However, the dilemma poses that (un)necessary prolonged disqualification of athletes to avoid adverse cardiac events can cause considerable disruption to training schedules and tournament preparation and lead to a decline in performance and ability to compete. Therefore, better risk stratification tools are imperatively needed. Using latest available data, this review contrasts existing recommendations and presents a new proposed diagnostic flowchart putting a greater focus on the use of cardiac magnetic resonance imaging in athletes with suspected myocarditis. This may enable cardiac caregivers to counsel athletes with suspected myocarditis more systematically and furthermore allow for pooling of more unified data. To modify recommendations regarding sports behavior in athletes with myocarditis, evidence, based on large multicenter registries including cardiac magnetic resonance imaging and endomyocardial biopsy, is needed. In the future, physicians might rely on combined novel risk stratification methods, by implementing both noninvasive and invasive tissue characterization methods.
- cardiac magnetic resonance imaging
- risk stratification
- sports restriction
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dudley Pennell, MD, served as Guest Editor for this paper.
- Received September 25, 2018.
- Revision received December 10, 2018.
- Accepted January 5, 2019.
- 2020 American College of Cardiology Foundation
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