Myocarditis – A silent killer in athletes: Comparative analysis on the evidence before and after COVID-19 pandemic

IF 2.3 Q2 SPORT SCIENCES Sports Medicine and Health Science Pub Date : 2024-03-16 DOI:10.1016/j.smhs.2024.03.003
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Abstract

Myocarditis is a rare cardiomyocyte inflammatory process, typically caused by viruses, with potentially devastating cardiac sequalae in both competitive athletes and in the general population. Investigation into myocarditis prevalence in the Coronavirus disease 2019 (COVID-19) era suggests that infection with Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is an independent risk factor for myocarditis, which is confirmed mainly through cardiovascular magnetic resonance imaging. Recent studies indicated that athletes have a decreased risk of myocarditis after recent COVID-19 infection compared to the general population. However, given the unique nature of competitive athletics with their frequent participation in high-intensity exercise, athletes possess distinct factors of susceptibility for the development of myocarditis and its subsequent severe cardiac complications (e.g., sudden cardiac death, fulminant heart failure, etc.). Under this context, this review focuses on comparing myocarditis in athletes versus non-athletes, owing special attention to the distinct clinical presentations and outcomes of myocarditis caused by different viral pathogens such as cytomegalovirus, Epstein-Barr virus, human herpesvirus-6, human immunodeficiency virus, and Parvovirus B19, both before and after the COVID-19 pandemic, as compared with SARS-CoV-2. By illustrating distinct clinical presentations and outcomes of myocarditis in athletes versus non-athletes, we also highlight the critical importance of early detection, vigilant monitoring, and effective management of viral and non-viral myocarditis in athletes and the necessity for further optimization of the return-to-play guidelines for athletes in the COVID-19 era, in order to minimize the risks for the rare but devastating cardiac fatality.

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心肌炎--运动员的隐形杀手:COVID-19 大流行前后的证据对比分析
心肌炎是一种罕见的心肌细胞炎症过程,通常由病毒引起,对竞技运动员和普通人群都有潜在的破坏性心脏后遗症。对 2019 年冠状病毒病(COVID-19)流行情况的调查表明,感染严重急性呼吸系统综合征冠状病毒(SARS-CoV-2)是心肌炎的独立危险因素,这主要通过心血管磁共振成像得到证实。最近的研究表明,与普通人群相比,运动员近期感染 COVID-19 后患心肌炎的风险降低。然而,由于竞技体育的特殊性,运动员经常参加高强度运动,因此他们对心肌炎及其随后的严重心脏并发症(如心脏性猝死、暴发性心力衰竭等)具有独特的易感因素。在此背景下,本综述侧重于比较运动员与非运动员的心肌炎情况,特别关注不同病毒病原体(如巨细胞病毒、爱泼斯坦-巴氏病毒、人类疱疹病毒-6、人类免疫缺陷病毒和副病毒 B19)引起的心肌炎在 COVID-19 大流行前后与 SARS-CoV-2 相比的不同临床表现和结果。通过说明运动员与非运动员心肌炎不同的临床表现和结果,我们还强调了早期发现、警惕监测和有效管理运动员病毒性和非病毒性心肌炎的极端重要性,以及在 COVID-19 时代进一步优化运动员重返赛场指南的必要性,以最大限度地降低罕见但具有破坏性的心脏致死风险。
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来源期刊
Sports Medicine and Health Science
Sports Medicine and Health Science Health Professions-Physical Therapy, Sports Therapy and Rehabilitation
CiteScore
5.50
自引率
0.00%
发文量
36
审稿时长
55 days
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