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The Grey Zone and the Complexity of Clinical Decisions in Sports Cardiology

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Abstract

We present here three different clinical scenarios that illustrate the complexity of taking decisions in sports cardiology. Despite the availability of consensus documents, in clinical practice, decision-making process is most of the times in the grey zone.

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References

  1. Drezner, J. A., Sharma, S., Baggish, A., Papadakis, M., Wilson, M. G., Prutkin, J. M., et al. (2017). International criteria for electrocardiographic interpretation in athletes: Consensus statement. British Journal of Sports Medicine, 51(9), 704–731. https://doi.org/10.1136/bjsports-2016-097331.

    Article  PubMed  Google Scholar 

  2. Maron, B. J., Udelson, J. E., Bonow, R. O., Nishimura, R. A., Ackerman, M. J., Estes, N. A. M., … Maron, M. S. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 3: Hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: A scientific statement from the American Heart Association and American College of Cardiology. Circulation. Lippincott Williams and Wilkins. https://doi.org/10.1161/CIR.0000000000000239

  3. Pelliccia, A., Solberg, E. E., Papadakis, M., Adami, P. E., Biffi, A., Caselli, S., et al. (2019). Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: Position statement of the sport cardiology section of the European Association of Preventive Cardiology (EAPC). European Heart Journal, 40(1), 19–33. https://doi.org/10.1093/eurheartj/ehy730.

    Article  PubMed  Google Scholar 

  4. Thompson, P. D., Myerburg, R. J., Levine, B. D., Udelson, J. E., & Kovacs, R. J. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 8: coronary artery disease: A scientific statement from the American Heart Association and American College of Cardiology. Circulation, 132(22), e310–e314. https://doi.org/10.1161/CIR.0000000000000244.

    Article  PubMed  Google Scholar 

  5. Borjesson, M., Dellborg, M., Niebauer, J., LaGerche, A., Schmied, C., Solberg, E. E., et al. (2018). Recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: A position statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC). European Heart Journal, 40(1), 13–18. https://doi.org/10.1093/eurheartj/ehy408.

    Article  Google Scholar 

  6. Aschieri, D., Penela, D., Pelizzoni, V., Guerra, F., Vermi, A. C., Rossi, L., et al. (2018). Outcomes after sudden cardiac arrest in sports centres with and without on-site external defibrillators. Heart, 104(16), 1344–1349. https://doi.org/10.1136/heartjnl-2017-312441.

    Article  PubMed  Google Scholar 

  7. Kinoshi, T., Tanaka, S., Sagisaka, R., Hara, T., Shirakawa, T., Sone, E., et al. (2018, August 2). Mobile automated external defibrillator response system during road races. New England Journal of Medicine. Massachussetts Medical Society. https://doi.org/10.1056/NEJMc1803218.

  8. Schumm, J., Greulich, S., Wagner, A., Grün, S., Ong, P., Bentz, K., et al. (2014). Cardiovascular magnetic resonance risk stratification in patients with clinically suspected myocarditis. Journal of Cardiovascular Magnetic Resonance, 16(1). https://doi.org/10.1186/1532-429X-16-14.

  9. Becker, M. A. J., Cornel, J. H., van de Ven, P. M., van Rossum, A. C., Allaart, C. P., & Germans, T. (2018). The prognostic value of late gadolinium-enhanced cardiac magnetic resonance imaging in nonischemic dilated cardiomyopathy: A review and meta-analysis. JACC: Cardiovascular Imaging, 11(9), 1274–1284. https://doi.org/10.1016/j.jcmg.2018.03.006.

    Article  PubMed  Google Scholar 

  10. Gräni, C., Eichhorn, C., Bière, L., Murthy, V. L., Agarwal, V., Kaneko, K., et al. (2017). Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. Journal of the American College of Cardiology, 70(16), 1964–1976. https://doi.org/10.1016/j.jacc.2017.08.050.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Aquaro, G. D., Perfetti, M., Camastra, G., Monti, L., Dellegrottaglie, S., Moro, C., et al. (2017). Cardiac MR with late gadolinium enhancement in acute myocarditis with preserved systolic function: ITAMY Study. Journal of the American College of Cardiology, 70(16), 1977–1987. https://doi.org/10.1016/j.jacc.2017.08.044.

    Article  PubMed  Google Scholar 

  12. Schnell, F., Claessen, G., La Gerche, A., Bogaert, J., Lentz, P. A., Claus, P., et al. (2016). Subepicardial delayed gadolinium enhancement in asymptomatic athletes: Let sleeping dogs lie? British Journal of Sports Medicine, 50(2), 111–117. https://doi.org/10.1136/bjsports-2014-094546.

    Article  PubMed  Google Scholar 

  13. Zorzi, A., Marra, M. P., Rigato, I., De Lazzari, M., Susana, A., Niero, A., et al. (2016). Nonischemic left ventricular scar as a substrate of life-threatening ventricular arrhythmias and sudden cardiac death in competitive athletes. Circulation: Arrhythmia and Electrophysiology, 9(7). https://doi.org/10.1161/CIRCEP.116.004229.

  14. Erbel, R., Aboyans, V., Boileau, C., Bossone, E., Di Bartolomeo, R., Eggebrecht, H., et al. (2014). 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. European Heart Journal, 35(41), 2873–2926. https://doi.org/10.1093/eurheartj/ehu281.

    Article  PubMed  Google Scholar 

  15. Boraita, A., Heras, M. E., Morales, F., Marina-Breysse, M., Canda, A., Rabadan, M., et al. (2016). Reference values of aortic root in male and female white elite athletes according to sport. Circulation: Cardiovascular Imaging, 9(10). https://doi.org/10.1161/CIRCIMAGING.116.005292.

  16. Baumgartner, H., Falk, V., Bax, J. J., De Bonis, M., Hamm, C., Holm, P. J., et al. (2017). 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 38. https://doi.org/10.1093/eurheartj/ehx391.

  17. Pelliccia, A., Caselli, S., Sharma, S., Basso, C., Bax, J. J., Corrado, D., et al. (2018, June 1). European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: Recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart. European Heart Journal. Oxford University Press. https://doi.org/10.1093/eurheartj/ehx532.

  18. Bonow, R. O., Nishimura, R. A., Thompson, P. D., & Udelson, J. E. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 5: Valvular heart disease: A scientific statement from the American Heart Association and American College of Cardiology. Journal of the American College of Cardiology, 66(21), 2385–2392. https://doi.org/10.1016/j.jacc.2015.09.037.

    Article  PubMed  Google Scholar 

  19. Braverman, A. C., Harris, K. M., Kovacs, R. J., & Maron, B. J. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 7: Aortic diseases, including Marfan syndrome: A scientific statement from the American Heart Association and American College of Cardiology. Journal of the American College of Cardiology, 66(21), 2398–2405 10.1 1.

    Article  Google Scholar 

  20. Boraita, A., Morales-Acuna, F., Marina-Breysse, M., Heras, M. E., Canda, A., Fuentes, M. E., et al. (2019). Bicuspid aortic valve behaviour in elite athletes. European Heart Journal Cardiovascular Imaging, 20(7), 772–780. https://doi.org/10.1093/ehjci/jez001.

    Article  PubMed  Google Scholar 

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Author information

Author notes

  1. María Alcocer-Ayuga, Zigor Madaria and Mari Dolores Masia contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Sports Medicine Center, Spanish Sports Health Protection Agency, Consejo Superior de Deportes, Madrid, Spain

    María Alcocer-Ayuga, Eugenia Heras Gómez & Araceli Boraita

  2. Agencia Española para la Protección de la Salud en el Deporte, Unidad de Cardiología, C/ Pintor El Greco s/n, 28040, Madrid, Spain

    María Alcocer-Ayuga, Eugenia Heras Gómez & Araceli Boraita

  3. H. Urduliz. Cardiology, Goieta Kalea, 32, 48610, Urduliz, Bizkaia, Spain

    Zigor Madaria, Gaizka Nuñez, Marta Pinedo & Ignacio Diez

  4. Hospital IMED Levante/Elche, Alicante, Spain

    Mari Dolores Masia

  5. Servicio Cardiología deportiva IMED Levante, C/Dr. Santiago Ramón y Cajal, 7, 03503, Benidorm, Spain

    Mari Dolores Masia

  6. Cemtro Clinic, Madrid, Spain

    Leonel Diaz-Gonzalez

  7. Cardiovascular Imaging Unit, ERESA Medical Center, Valencia, Spain

    Alicia Maceira

Authors
  1. María Alcocer-Ayuga
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  2. Zigor Madaria
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  3. Mari Dolores Masia
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  4. Gaizka Nuñez
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  5. Eugenia Heras Gómez
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  6. Marta Pinedo
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  7. Ignacio Diez
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  8. Leonel Diaz-Gonzalez
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  9. Alicia Maceira
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  10. Araceli Boraita
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Corresponding authors

Correspondence to María Alcocer-Ayuga, Zigor Madaria or Mari Dolores Masia.

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Associate Editor Domingo A. Pascual-Figal oversaw the review of this article

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Alcocer-Ayuga, M., Madaria, Z., Masia, M.D. et al. The Grey Zone and the Complexity of Clinical Decisions in Sports Cardiology. J. of Cardiovasc. Trans. Res. 13, 339–344 (2020). https://doi.org/10.1007/s12265-020-10046-z

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  • DOI: https://doi.org/10.1007/s12265-020-10046-z

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