Miyokardit Sonrası Spora Katılım
Özet
Sporcu çocuklarda ortaya çıkan bazı rahatsızlıklar spor hayatlarını olumsuz yönde etkileyebilir. Miyokardit, sporcularda sık rastlanan önemli hastalıklardan biridir. Miyokardın noniskemik nekrozu ve dejenerasyonu ile giden miyokardit, ani kardiyak ölümlerin önemli bir sebebidir. Özellikle akut ve kronik dönemde miyokard yapısındaki değişiklikler nedeniyle önemli ölümcül aritmiler görülebilir, aynı zamanda dilate kardiyomiyopati gelişebilir. Ön planda etyolojide virüsler yer almaktadır. Sıklıkla kalp yetersizliği semptomları ile başvururlar. Tanıda ekokardiyografi ve magnetik rezonans görüntüleme önemli yer tutmaktadır. Spesifik bir tedavisi olmayıp semptomlara yönelik tedavi yapılmaktadır. Ancak tedavi sonrası sporcu çocukların 3-6 ay yarışmalı sporlardan uzak kalmaları önerilir. Bu sürenin sonunda spora dönmeden önce çeşitli tanı yöntemleri ile değerlendirilmeleri gerekir.
Referanslar
Harmon KG, Asif IM, Maleszewski JJ, et al. Incidence, cause, and comparative frequency of sudden cardiac death in National Collegiate Athletic Association athletes: a decade in review. Circulation 2015;132:10–9.
Vassalini M, Verzeletti A, Restori M, De Ferrari F. An autopsy study of sudden cardiac death in persons aged 1–40 years in Brescia (Italy). J Cardiovasc Med (Hagerstown) 2016;17:446–53.
Sinagra G, Anzini M, Pereira NL, Bussani R, Finocchiaro G, Bartunek J, Merlo M. Myocarditis in Clinical Practice. Mayo Clin Proc 2016;91:1256–1266. 105.
Kim J, Cho MJ. Acute Myocarditis in Children: a 10-year Nationwide Study (2007-2016) based on the Health Insurance Review and Assessment Service Database in Korea. Korean Circ J. 2020;50(11):1013-22.
Bryde RE, Cooper LT Jr, Fairweather D, Di Florio DN, Martinez MW. Exercise After Acute Myocarditis: When and How to Return to Sports.Cardiol Clin. 2023 Feb;41(1):107-115. doi: 10.1016/j.ccl.2022.08.009.
Sagar S, Liu PP, Cooper LT. Myocarditis. Lancet 2012;379:738–47
Schultheiss H-P, Fairweather D, Caforio AL, et al. Dilated cardiomyopathy. Nat Rev Dis primers 2019; 5(1):1–19
Phillips MD, Flynn MG, McFarlin BK, Stewart LK, Timmerman KL. Resistance training at eight-repetition maximum reduces the inflammatory milieu in elderly Curr Treat Options Cardio Med (2020) 22: 65 Page 9 of 11 65 women. Med Sci Sports Exerc. 2010;42(2):314–25. https://doi.org/10.1249/MSS.0b013e3181b11ab7
Suzui M, Kawai T, Kimura H, et al. Natural killer cell lytic activity and CD56(dim) and CD56(bright) cell distributions during and after intensive training. J Appl Physiol. 2004;96(6):2167–73. https://doi.org/10.1152/ japplphysiol.00513.2003.
Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013;34(33):2636–48.
Petek BJ, Moulson N, Baggish AL, et al. Prevalence and clinical implications of persistent or exertional cardiopulmonary symptoms following SARS-CoV-2 infection in 3597 collegiate athletes: a study from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA). Br J Sports Med 2021;56(16): 913–8.
Committee W, Gluckman TJ, Bhave NM, et al. 2022 ACC expert Consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American College of cardiology solution set oversight committee. J Am Coll Cardiol 2022; 79(17):1717–56. https://doi.org/10.1016/j.jacc.2022. 02.003.
Eichhorn C, Bière L, Schnell F, et al. Myocarditis in athletes is a challenge: diagnosis, risk stratification, and uncertainties. JACC Cardiovasc Imaging. 2020;13(2 Pt 1):494–507. https://doi.org/10.1016/j.jcmg.2019.01. 039. Epub 2019 Jun 12.
Wu C, Singh A, Collins B, et al. Causes of troponin elevation and associated mortality in young patients. Am J Med 2018;131:284–92.e1.
Berg J, Kottwitz J, Baltensperger N, et al. Cardiac magnetic resonance imaging in myocarditis reveals persistent disease activity despite normalization of cardiac enzymes and inflammatory parameters at 3-month follow-up. Circ Heart Fail 2017;10:e004262.
Schnell F, Riding N, O’Hanlon R, et al. Recognition and significance of pathological T-wave inversions in athletes. Circulation 2015;131:165–73.
Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med 1975;82:521–4.
Pinamonti B, Alberti E, Cigalotto A, et al. Echocardiographic findings in myocarditis. Am J Cardiol 1988;62:285–91.
Damm S, Andersson LG, Henriksen E, et al. Wall motion abnormalities in male elite orienteers are aggravated by exercise. Clin Physiol 1999;19: 121–6.
Lurz P, Luecke C, Eitel I, et al. Comprehensive cardiac magnetic resonance imaging in patients with suspected myocarditis: the MyoRacer-Trial. J Am Coll Cardiol 2016;67:1800–11.
Luetkens JA, Faron A, Isaak A, et al. Comparison of original and 2018 Lake Louise Criteria for diagnosis of acute myocarditis: results of a validation cohort. Radiol Cardiothorac Imaging. 2019;1(3):e190010.
Hurwitz B, Issa O. Management and Treatment of Myocarditis in Athletes. Curr Treat Options Cardiovasc Med. 2020;22(12):65. doi: 10.1007/s11936-020-00875-1. Epub 2020 Nov 4.
Zorzi A, Perazzolo Marra M, Rigato I, et al. Nonischemic left ventricular scar as a substrate of lifethreatening ventricular arrhythmias and sudden cardiac death in competitive athletes. Circ Arrhythm Electrophysiol. 2016;9(7):e004229. https://doi.org/10. 1161/CIRCEP.116.004229.
Aquaro GD, Perfetti M, Camastra G, et al. Cardiac MR with late gadolinium enhancement in acute myocarditis with preserved systolic function. J Am Coll Cardiol. 2017;70(16):1977–87. https://doi.org/10.1016/j.jacc. 2017.08.044.
Kindermann I, Barth C, Mahfoud F, et al. Update on myocarditis. J Am Coll Cardiol. 2012;59(9):779–92. https://doi.org/10.1016/j.jacc.2011.09.074
Piepoli MF, Conraads V, Corra U, et al. Exercise training in heart failure: from theory to practice: a consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011;13:347–57.
Pelliccia A, Solberg EE, Papadakis M, et all. 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). Eur Heart J. 2019 Jan 1;40(1):19-33. doi: 10.1093/eurheartj/ehy730
Referanslar
Harmon KG, Asif IM, Maleszewski JJ, et al. Incidence, cause, and comparative frequency of sudden cardiac death in National Collegiate Athletic Association athletes: a decade in review. Circulation 2015;132:10–9.
Vassalini M, Verzeletti A, Restori M, De Ferrari F. An autopsy study of sudden cardiac death in persons aged 1–40 years in Brescia (Italy). J Cardiovasc Med (Hagerstown) 2016;17:446–53.
Sinagra G, Anzini M, Pereira NL, Bussani R, Finocchiaro G, Bartunek J, Merlo M. Myocarditis in Clinical Practice. Mayo Clin Proc 2016;91:1256–1266. 105.
Kim J, Cho MJ. Acute Myocarditis in Children: a 10-year Nationwide Study (2007-2016) based on the Health Insurance Review and Assessment Service Database in Korea. Korean Circ J. 2020;50(11):1013-22.
Bryde RE, Cooper LT Jr, Fairweather D, Di Florio DN, Martinez MW. Exercise After Acute Myocarditis: When and How to Return to Sports.Cardiol Clin. 2023 Feb;41(1):107-115. doi: 10.1016/j.ccl.2022.08.009.
Sagar S, Liu PP, Cooper LT. Myocarditis. Lancet 2012;379:738–47
Schultheiss H-P, Fairweather D, Caforio AL, et al. Dilated cardiomyopathy. Nat Rev Dis primers 2019; 5(1):1–19
Phillips MD, Flynn MG, McFarlin BK, Stewart LK, Timmerman KL. Resistance training at eight-repetition maximum reduces the inflammatory milieu in elderly Curr Treat Options Cardio Med (2020) 22: 65 Page 9 of 11 65 women. Med Sci Sports Exerc. 2010;42(2):314–25. https://doi.org/10.1249/MSS.0b013e3181b11ab7
Suzui M, Kawai T, Kimura H, et al. Natural killer cell lytic activity and CD56(dim) and CD56(bright) cell distributions during and after intensive training. J Appl Physiol. 2004;96(6):2167–73. https://doi.org/10.1152/ japplphysiol.00513.2003.
Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013;34(33):2636–48.
Petek BJ, Moulson N, Baggish AL, et al. Prevalence and clinical implications of persistent or exertional cardiopulmonary symptoms following SARS-CoV-2 infection in 3597 collegiate athletes: a study from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA). Br J Sports Med 2021;56(16): 913–8.
Committee W, Gluckman TJ, Bhave NM, et al. 2022 ACC expert Consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American College of cardiology solution set oversight committee. J Am Coll Cardiol 2022; 79(17):1717–56. https://doi.org/10.1016/j.jacc.2022. 02.003.
Eichhorn C, Bière L, Schnell F, et al. Myocarditis in athletes is a challenge: diagnosis, risk stratification, and uncertainties. JACC Cardiovasc Imaging. 2020;13(2 Pt 1):494–507. https://doi.org/10.1016/j.jcmg.2019.01. 039. Epub 2019 Jun 12.
Wu C, Singh A, Collins B, et al. Causes of troponin elevation and associated mortality in young patients. Am J Med 2018;131:284–92.e1.
Berg J, Kottwitz J, Baltensperger N, et al. Cardiac magnetic resonance imaging in myocarditis reveals persistent disease activity despite normalization of cardiac enzymes and inflammatory parameters at 3-month follow-up. Circ Heart Fail 2017;10:e004262.
Schnell F, Riding N, O’Hanlon R, et al. Recognition and significance of pathological T-wave inversions in athletes. Circulation 2015;131:165–73.
Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med 1975;82:521–4.
Pinamonti B, Alberti E, Cigalotto A, et al. Echocardiographic findings in myocarditis. Am J Cardiol 1988;62:285–91.
Damm S, Andersson LG, Henriksen E, et al. Wall motion abnormalities in male elite orienteers are aggravated by exercise. Clin Physiol 1999;19: 121–6.
Lurz P, Luecke C, Eitel I, et al. Comprehensive cardiac magnetic resonance imaging in patients with suspected myocarditis: the MyoRacer-Trial. J Am Coll Cardiol 2016;67:1800–11.
Luetkens JA, Faron A, Isaak A, et al. Comparison of original and 2018 Lake Louise Criteria for diagnosis of acute myocarditis: results of a validation cohort. Radiol Cardiothorac Imaging. 2019;1(3):e190010.
Hurwitz B, Issa O. Management and Treatment of Myocarditis in Athletes. Curr Treat Options Cardiovasc Med. 2020;22(12):65. doi: 10.1007/s11936-020-00875-1. Epub 2020 Nov 4.
Zorzi A, Perazzolo Marra M, Rigato I, et al. Nonischemic left ventricular scar as a substrate of lifethreatening ventricular arrhythmias and sudden cardiac death in competitive athletes. Circ Arrhythm Electrophysiol. 2016;9(7):e004229. https://doi.org/10. 1161/CIRCEP.116.004229.
Aquaro GD, Perfetti M, Camastra G, et al. Cardiac MR with late gadolinium enhancement in acute myocarditis with preserved systolic function. J Am Coll Cardiol. 2017;70(16):1977–87. https://doi.org/10.1016/j.jacc. 2017.08.044.
Kindermann I, Barth C, Mahfoud F, et al. Update on myocarditis. J Am Coll Cardiol. 2012;59(9):779–92. https://doi.org/10.1016/j.jacc.2011.09.074
Piepoli MF, Conraads V, Corra U, et al. Exercise training in heart failure: from theory to practice: a consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011;13:347–57.
Pelliccia A, Solberg EE, Papadakis M, et all. 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). Eur Heart J. 2019 Jan 1;40(1):19-33. doi: 10.1093/eurheartj/ehy730
