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A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 20330

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Special Issue Editor

Dr. David L. Oxborough

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Guest Editor

Research Institute for Sports and Exercise Science and the Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 3AF, UK
Interests: echocardiography; cardiovascular physiology; sports cardiology; exercise; inherited cardiac conditions

Special Issue Information

Dear Colleagues,

Sports cardiology is a developing specialism that integrates the prevention, diagnosis, and management of individuals involved in sport and exercise. This transcends other cardiology disciplines including inherited and acquired cardiac conditions; hence, there are important multi-disciplinary and modality applications. This Special Issue aims to provide a platform for high-quality publications related to the discipline of sports cardiology. We welcome submissions from original research, case reports, and review articles that highlight the current and evolving areas of this specialism. These can include but are not restricted to diagnostics, screening, secondary care, and management of those individuals involved in structured exercise.

Dr. David Oxborough
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

athletes’ heart
sport
exercise
screening
echocardiography
electrocardiography
sudden cardiac death

Published Papers (10 papers)

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Research

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11 pages, 887 KiB

Open AccessArticle

The Improvement of Left Atrial Function after Twelve Weeks of Supervised Concurrent Training in Patients with Heart Failure with Mid-Range Ejection Fraction: A Pilot Study

by Giuseppe Caminiti, Marco Alfonso Perrone, Valentino D’Antoni, Giuseppe Marazzi, Alessandro Gismondi, Sara Vadalà, Deborah Di Biasio, Vincenzo Manzi, Ferdinando Iellamo and Maurizio Volterrani

J. Cardiovasc. Dev. Dis. 2023, 10(7), 276; https://doi.org/10.3390/jcdd10070276 - 29 Jun 2023

Cited by 1 | Viewed by 892

Abstract

Left atrial dysfunction is associated with exercise intolerance and poor prognosis in heart failure (HF). The effects of exercise training on atrial function in patients with HF with mid-range ejection fraction (HFmrEF) are unknown. The purpose of the present study was to assess the effects of a supervised concurrent training (SCT) program, lasting 12 weeks, on left atrial function of patients with HFmrEF. The study included 70 stable patients, who were randomly assigned into two groups: SCT with (three sessions/week) or a control (CON) group directed to follow contemporary exercise preventive guidelines at home. Before starting the training program and at 12 weeks, all patients performed an ergometric test, a 6 min walk test, and echocardiography. Between-group comparisons were made by analysis of variance (ANOVA). At 12 weeks, the duration of the ergometric test and distance walked at 6 min walk test presented a significant greater increase in SCT compared to the control (between-group p 0.0001 and p 0.004 respectively). Peak atrial longitudinal strain and conduit strain presented an increase of 29% and 34%, respectively, in the SCT, and were unchanged in CON (between-group p 0.008 and p 0.001, respectively). Peak atrial contraction strain increased by 21% in SCT, with no changes in CON (between-group p 0.002). Left ventricular global longitudinal strain increased significantly in SCT compared to control (between-groups p 0.03). In conclusions, SCT improved left atrial and left ventricular function in HFmrEF. Further studies are needed in order to verify whether these favourable effects of SCT on LA function are sustained and whether they will translate into clinical benefits for patients with HFmrEF. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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14 pages, 4118 KiB

Open AccessArticle

A New Tool to Aid the Differential Diagnosis of Physiological Remodelling from Cardiac Pathology When Assessing Left Ventricle, Left Atrial and Aortic Structure and Function in Male Arab and Black Paediatric Athletes

by Gavin McClean, Mathew G. Wilson, Nathan R. Riding, Guido Pieles, Victoria Watt, Carmen Adamuz, Anthony Shaw, Allan Harkness, Amanda Johnson, Keith P. George and David Oxborough

J. Cardiovasc. Dev. Dis. 2023, 10(2), 37; https://doi.org/10.3390/jcdd10020037 - 20 Jan 2023

Cited by 2 | Viewed by 1411

Abstract

Aim: To determine if published Z-scores for left ventricular (LV), left atrial (LA) and aortic structure as well as indices of LV function (Doppler and TDI) in paediatric athletes and non-athletes are appropriate for application in male Arab and black paediatric athletes. If inappropriate, we aim to provide new nomograms and Z-scores for clinical application. Methods: 417 (297 Arab, 120 black) male paediatric (11–18 years) athletes, were evaluated by 2D echocardiography as per British Society of Echocardiography recommendations, and biological age (by radiological X-ray) assessment. Z-scores were tested by residual and correlation analysis together with visual inspection. New Z-scores involved allometric (

a * B S A^{(b + c * c h r o n o l o g i c a l a g e)}

) and second-order polynomial

(y = a * c h r o n o l o g i c a l a g e^{2} + b * c h r o n o l o g i c a l a g e + c)

equations for measures of cardiac size and indices of LV function, respectively. Results: Residual linear regression, correlation analysis and visual inspection revealed published z-scores in white peri-pubertal footballers and paediatric non-athletes to be inappropriate for application in male Arab and black paediatric athletes. Residual linear regression revealed new Z-scores for measures of LV, LA and aortic root size to be independent of BSA, ethnicity, chronological and biological age. Residual linear regression revealed new Z-scores for measures of function to be independent of chronological age. Conclusion: Our new z-scores may aid differential diagnosis of suspected pathology versus physiology remodelling, in cardiac screening of the Arab and black paediatric athlete. Nomograms are provided to assist the tracking of the paediatric athlete necessitating annual follow-up and Excel z-score calculation to facilitate use in day-to-day practice. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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10 pages, 1446 KiB

Open AccessArticle

Improved VO_2max Estimation by Combining a Multiple Regression Model and Linear Extrapolation Method

by Tomoaki Matsuo, Rina So and Fumiko Murai

J. Cardiovasc. Dev. Dis. 2023, 10(1), 9; https://doi.org/10.3390/jcdd10010009 - 27 Dec 2022

Cited by 2 | Viewed by 1629

Abstract

Maximal oxygen consumption (VO_2max) is an important health indicator that is often estimated using a multiple regression model (MRM) or linear extrapolation method (LEM) with the heart rate (HR) during a step test. Nonetheless, both methods have inherent problems. This study investigated a VO_2max estimation method that mitigates the weaknesses of these two methods. A total of 128 adults completed anthropometric measurements, a physical activity questionnaire, a step test with HR measurements, and a VO_2max treadmill test. The MRM included step-test HR, age, sex, body mass index, and questionnaire scores, whereas the LEM included step-test HR, predetermined constant VO₂ values, and age-predicted maximal HR. Systematic differences between estimated and measured VO_2max values were detected using Bland–Altman plots. The standard errors of the estimates of the MRM and LEM were 4.15 and 5.08 mL·kg⁻¹·min⁻¹, respectively. The range of 95% limits of agreement for the LEM was wider than that for the MRM. Fixed biases were not significant for both methods, and a significant proportional bias was observed only in the MRM. MRM bias was eliminated using the LEM application when the MRM-estimated VO_2max was ≥45 mL·kg⁻¹·min⁻¹. In conclusion, substantial proportional bias in the MRM may be mitigated using the LEM within a limited range. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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9 pages, 953 KiB

Open AccessArticle

Exercise and Escitalopram in the Treatment of Anxiety in Patients with Coronary Heart Disease: One Year Follow-Up of the UNWIND Randomized Clinical Trial

by James A. Blumenthal, Patrick J. Smith, Wei Jiang, Alan Hinderliter, Lana L. Watkins, Benson M. Hoffman, William E. Kraus, Stephanie Mabe, Lawrence Liao, Jonathan Davidson and Andrew Sherwood

J. Cardiovasc. Dev. Dis. 2022, 9(10), 320; https://doi.org/10.3390/jcdd9100320 - 22 Sep 2022

Cited by 2 | Viewed by 2213

Abstract

Anxiety is common among patients with coronary heart disease (CHD) and is associated with a worse prognosis. UNWIND was a 12-week randomized clinical trial comparing exercise and escitalopram to placebo on measures of anxiety, depression, and CHD biomarkers. Primary results of the trial reported that treatment with escitalopram, but not exercise, was associated with significant reductions in anxiety and depression. At 1-year follow-up, participants completed the Hospital Anxiety-Depression Scale-Anxiety (HADS-A) along with the HADS-Depression (HADS-D), the Beck Depression Inventory-II (BDI-II), and the Godin Leisure Time Exercise survey to assess physical activity. Results showed that those patients randomized to escitalopram had lower scores on the HADS-A compared to those randomized to exercise (P = 0.006) and had less depression compared to exercise on the HADS-D (P = 0.004) and BDI-II (P = 0.004). Participants randomized to exercise reported higher levels of physical activity at 1-year compared to those randomized to Placebo (P = 0.039). However, despite reporting being more physically active, those randomized to exercise did not have less anxiety or depression compared to placebo controls. Escitalopram appears to be a safe and effective treatment for anxiety; exercise has many health benefits, but does not appear to be effective in treating anxiety. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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14 pages, 1073 KiB

Open AccessArticle

Physiological Effects of Training in Elite German Winter Sport Athletes: Sport Specific Remodeling Determined Using Echocardiographic Data and CPET Performance Parameters

by Paul Zimmermann, Isabelle Schöffl, Volker Schöffl, Lukas Zimmermann, Max L. Eckstein, Othmar Moser and Jan Wüstenfeld

J. Cardiovasc. Dev. Dis. 2022, 9(8), 235; https://doi.org/10.3390/jcdd9080235 - 25 Jul 2022

Cited by 7 | Viewed by 1936

Abstract

Nine ski mountaineering (Ski-Mo), ten Nordic-cross country (NCC), and twelve world elite biathlon (Bia) athletes were evaluated for cardiopulmonary exercise test (CPET) performance and pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, a multicenter retrospective analysis of two-dimensional echocardiographic data including speckle tracking of the left ventricle (LV-GLS) and CPET performance analysis was performed in 31 elite world winter sports athletes, which were obtained during the annual sports medicine examination between 2020 and 2021. The matched data of the elite winter sports athletes (14 women, 17 male athletes, age: 18–32 years) were compared for different CPET and echocardiographic parameters, anthropometric data, and sport-specific training schedules. Significant differences could be revealed for left atrial (LA) remodeling by LA volume index (LAVI, p = 0.0052), LV-GLS (p = 0.0003), and LV mass index (LV Mass index, p = 0.0078) between the participating disciplines. All participating athletes showed excellent performance data in the CPET analyses, whereby significant differences were revealed for highest maximum respiratory minute volume (VE _maximum) and the maximum oxygen pulse level across the participating athletes. This study on sport specific physiological demands in elite winter sport athletes provides new evidence that significant differences in CPET and cardiac remodeling of the left heart can be identified based on the individual athlete’s training schedule, frequency, and physique. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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Review

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16 pages, 649 KiB

Open AccessReview

The Relationship between Changes in MYBPC3 Single-Nucleotide Polymorphism-Associated Metabolites and Elite Athletes’ Adaptive Cardiac Function

by Emna Riguene, Maria Theodoridou, Laila Barrak, Mohamed A. Elrayess and Michail Nomikos

J. Cardiovasc. Dev. Dis. 2023, 10(9), 400; https://doi.org/10.3390/jcdd10090400 - 18 Sep 2023

Cited by 3 | Viewed by 1533

Abstract

Athletic performance is a multifactorial trait influenced by a complex interaction of environmental and genetic factors. Over the last decades, understanding and improving elite athletes’ endurance and performance has become a real challenge for scientists. Significant tools include but are not limited to the development of molecular methods for talent identification, personalized exercise training, dietary requirements, prevention of exercise-related diseases, as well as the recognition of the structure and function of the genome in elite athletes. Investigating the genetic markers and phenotypes has become critical for elite endurance surveillance. The identification of genetic variants contributing to a predisposition for excellence in certain types of athletic activities has been difficult despite the relatively high genetic inheritance of athlete status. Metabolomics can potentially represent a useful approach for gaining a thorough understanding of various physiological states and for clarifying disorders caused by strength–endurance physical exercise. Based on a previous GWAS study, this manuscript aims to discuss the association of specific single-nucleotide polymorphisms (SNPs) located in the MYBPC3 gene encoding for cardiac MyBP-C protein with endurance athlete status. MYBPC3 is linked to elite athlete heart remodeling during or after exercise, but it could also be linked to the phenotype of cardiac hypertrophy (HCM). To make the distinction between both phenotypes, specific metabolites that are influenced by variants in the MYBPC3 gene are analyzed in relation to elite athletic performance and HCM. These include theophylline, ursodeoxycholate, quinate, and decanoyl-carnitine. According to the analysis of effect size, theophylline, quinate, and decanoyl carnitine increase with endurance while decreasing with cardiovascular disease, whereas ursodeoxycholate increases with cardiovascular disease. In conclusion, and based on our metabolomics data, the specific effects on athletic performance for each MYBPC3 SNP-associated metabolite are discussed. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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20 pages, 1506 KiB

Open AccessReview

An Overview of Sport Participation and Exercise Prescription in Mitral Valve Disease

by Francesco Perone, Mariangela Peruzzi, Edoardo Conte, Luigi Sciarra, Giacomo Frati, Elena Cavarretta and Annachiara Pingitore

J. Cardiovasc. Dev. Dis. 2023, 10(7), 304; https://doi.org/10.3390/jcdd10070304 - 18 Jul 2023

Cited by 2 | Viewed by 2516

Abstract

The incidence of heart valve disease (HVD) has been rising over the last few decades, mainly due to the increasing average age of the general population, and mitral valve (MV) disease is the second most prevalent HVD after calcific aortic stenosis, but MV disease is a heterogeneous group of different pathophysiological diseases. It is widely proven that regular physical activity reduces all-cause mortality rates, and exercise prescription is part of the medical recommendations for patients affected by cardiovascular diseases. However, changes in hemodynamic balance during physical exercise (including the increase in heart rate, preload, or afterload) could favor the progression of the MV disease and potentially trigger major cardiac events. In young patients with HVD, it is therefore important to define criteria for allowing competitive sport or exercise prescription, balancing the positive effects as well as the potential risks. This review focuses on mitral valve disease pathophysiology, diagnosis, risk stratification, exercise prescription, and competitive sport participation selection, and offers an overview of the principal mitral valve diseases with the aim of encouraging physicians to embody exercise in their daily practice when appropriate. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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16 pages, 347 KiB

Open AccessReview

Cardiac Biomarkers in Sports Cardiology

by Alexandru-Dan Costache, Maria-Magdalena Leon-Constantin, Mihai Roca, Alexandra Maștaleru, Răzvan-Constantin Anghel, Ioana-Mădălina Zota, Andrei Drugescu, Irina-Iuliana Costache, Adriana Chetran, Ștefana-Maria Moisă, Bogdan Huzum, Ovidiu Mitu, Carmen Cumpăt, Cezar Honceriu and Florin Mitu

J. Cardiovasc. Dev. Dis. 2022, 9(12), 453; https://doi.org/10.3390/jcdd9120453 - 11 Dec 2022

Cited by 3 | Viewed by 2122

Abstract

Sustained physical activity induces morphological and functional changes in the cardiovascular system. While mostly physiological, they can also become a trigger for major adverse cardiovascular events, the most severe of which are sudden cardiac arrest and sudden cardiac death. Therefore, any novel method which can help more accurately estimate the cardiovascular risk should be considered for further studying and future implementation in the standard protocols. The study of biomarkers is gaining more and more ground as they have already established their utility in diagnosing ischemic cardiac disease or in evaluating cardiac dysfunction in patients with heart failure. Nowadays, they are being implemented in the screening of apparently healthy individuals for the assessment of the cardiovascular risk. The aim of this paper is to gather published data regarding the measurements of cardiac biomarkers in athletes, i.e., troponins, myoglobin, CK-MB, NT-proBNP, and D-Dimers, and their potential use in the field of sports cardiology. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

14 pages, 2695 KiB

Open AccessReview

Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation

by Viswanath B. Unnithan, Alexander Beaumont, Thomas Rowland, Keith George, Nicholas Sculthorpe, Rachel N. Lord, Andisheh Bakhshi and David Oxborough

J. Cardiovasc. Dev. Dis. 2022, 9(12), 438; https://doi.org/10.3390/jcdd9120438 - 6 Dec 2022

Viewed by 1529

Abstract

There is an increase in the prevalence of elite youth sports academies, whose sole aim is to develop future elite athletes. This involves the exposure of the child and adolescent athlete to high-volume training during a period of volatile growth. The large amount of data in this area has been garnered from the resting echocardiographic left ventricular (LV) evaluation of the youth athlete; while this can provide some insight on the functional adaptations to training, it is unable to elucidate a comprehensive overview of the function of the youth athletes’ LV during exercise. Consequently, there is a need to interrogate the LV responses in-exercise. This review outlines the feasibility and functional insight of capturing global indices of LV function (Stroke Index-SVIndex and Cardiac Index-QIndex), systolic and diastolic markers, and cardiac strain during submaximal and maximal exercise. Larger SVI and QI were noted in these highly trained young athletes compared to recreationally active peers during submaximal and maximal exercise. The mechanistic insights suggest that there are minimal functional systolic adaptions during exercise compared to their recreationally active peers. Diastolic function was superior during exercise in these young athletes, and this appears to be underpinned by enhanced determinants of pre-load. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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16 pages, 934 KiB

Open AccessReview

The Athlete’s Heart and Machine Learning: A Review of Current Implementations and Gaps for Future Research

by Ryan A. A. Bellfield, Sandra Ortega-Martorell, Gregory Y. H. Lip, David Oxborough and Ivan Olier

J. Cardiovasc. Dev. Dis. 2022, 9(11), 382; https://doi.org/10.3390/jcdd9110382 - 8 Nov 2022

Cited by 4 | Viewed by 2875

Abstract

Background: Intense training exercise regimes cause physiological changes within the heart to help cope with the increased stress, known as the “athlete’s heart”. These changes can mask pathological changes, making them harder to diagnose and increasing the risk of an adverse cardiac outcome. Aim: This paper reviews which machine learning techniques (ML) are being used within athlete’s heart research and how they are being implemented, as well as assesses the uptake of these techniques within this area of research. Methods: Searches were carried out on the Scopus and PubMed online datasets and a scoping review was conducted on the studies which were identified. Results: Twenty-eight studies were included within the review, with ML being directly referenced within 16 (57%). A total of 12 different techniques were used, with the most popular being artificial neural networks and the most common implementation being to perform classification tasks. The review also highlighted the subgroups of interest: predictive modelling, reviews, and wearables, with most of the studies being attributed to the predictive modelling subgroup. The most common type of data used was the electrocardiogram (ECG), with echocardiograms being used the second most often. Conclusion: The results show that over the last 11 years, there has been a growing desire of leveraging ML techniques to help further the understanding of the athlete’s heart, whether it be by expanding the knowledge of the physiological changes or by improving the accuracies of models to help improve the treatments and disease management. Full article

(This article belongs to the Special Issue Recent Advances in Sports Cardiology)

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