Abstract
Myocardial inflammation is an important cause of cardiovascular morbidity and sudden cardiac death in athletes. The relationship between sports practice and myocardial inflammation is complex, and recent data from studies concerning cardiac magnetic resonance imaging and endomyocardial biopsy have substantially added to our understanding of the challenges encountered in the comprehensive care of athletes with myocarditis or inflammatory cardiomyopathy (ICM). In this review, we provide an overview of the current knowledge on the epidemiology, pathophysiology, diagnosis, and treatment of myocarditis, ICM, and myopericarditis/perimyocarditis in athletes, with a special emphasis on arrhythmias, patient-tailored therapies, and sports eligibility issues.
Highlights
Inflammatory diseases of the myocardium encompass an important group of disorders characterized by heterogeneous clinical presentation, ranging from asymptomatic to sudden cardiac death (SCD), often occurring in otherwise healthy subjects [1]
We summarize the current knowledge on the epidemiology, pathophysiology, diagnosis, and treatment of inflammatory diseases of the myocardium from a sports cardiology perspective, according to published international recommendations [6,7]—when available—and the experience of a referral center for the care of athletes with myocardial inflammation
The indication for the implantation of implantable cardioverter defibrillators (ICDs) in patients with acute myocarditis depends on several factors, which include the presence of ventricular arrhythmias, presence and localization of LGE by cardiac magnetic resonance (CMR) [55], the extension of low-voltage areas by electroanatomical voltage mapping (EVM) [5], and endomyocardial biopsy (EMB) evidence of giant cell myocarditis or cardiac sarcoidosis [36]
Summary
Inflammatory diseases of the myocardium encompass an important group of disorders characterized by heterogeneous clinical presentation, ranging from asymptomatic to sudden cardiac death (SCD), often occurring in otherwise healthy subjects [1]. The basic glossary includes myocarditis, defined as an inflammatory disease of the myocardium characterized by histological evidence of inflammatory infiltrates within the myocardium associated with myocyte degeneration and necrosis of non-ischemic origin, and inflammatory cardiomyopathy (ICM), defined as myocarditis associated with cardiac dysfunction [1]. We summarize the current knowledge on the epidemiology, pathophysiology, diagnosis, and treatment of inflammatory diseases of the myocardium from a sports cardiology perspective, according to published international recommendations [6,7]—when available—and the experience of a referral center for the care of athletes with myocardial inflammation
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