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The Present and Future of Sports Cardiology and Exercise, 2nd...
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The Present and Future of Sports Cardiology and Exercise, 2nd Edition

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

Deadline for manuscript submissions: 31 July 2026 | Viewed by 3895

Special Issue Editor

Dr. Elena Cavarretta

E-Mail Website
Guest Editor
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 40100 Latina, Italy
Interests: sports cardiology; exercise; athlete's heart; echocardiography; oxidative stress; exercise prescription; electrocardiogram
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The multifaceted sub-specialty of sports cardiology and exercise has gained momentum in the recent years not only for the importance of pre-participation screening in the prevention of sudden cardiac death but also in the personalised exercise prescription as part of the clinical management of cardiovascular diseases. In addition, different populations in sports cardiology are emerging as master athletes, paediatric athletes, and e-athletes, possessing specific characteristics that merit attention.

This Special Issue aims to cover all aspects of the different sub-fields of sports cardiology and exercise. Original articles and case series, as well as high-quality narrative reviews, systematic reviews, and meta-analyses are welcome. We would particularly appreciate contributions on the following topics:

  • Multimodality imaging assessment in the differential diagnosis between athletes’ hearts and cardiovascular diseases;
  • Pre-participation screening of athletes’ hearts;
  • Female athletes’ hearts;
  • Paediatric athletes;
  • Master athletes;
  • Novelties in the evaluation and management of athletes with cardiovascular diseases;
  • Risk assessment and management for the prevention of sudden cardiac death in athletes;
  • The role of cardiovascular imaging in sports cardiology and exercise;
  • Risk stratification with cardiovascular imaging in young athletes with cardiovascular diseases;
  • Exercise prescription in patients with cardiovascular disease, diabetes, and obesity;
  • The emerging field of e-sports and e-athletes;
  • Cardiac rehabilitation and pre-habilitation.

Dr. Elena Cavarretta
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 250 words) can be sent to the Editorial Office for assessment.

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

  • sports cardiology
  • exercise
  • exercise prescription
  • electrocardiogram
  • echocardiography
  • oxidative stress
  • cardiomyopathy
  • heart valve disease
  • preventive cardiology
  • cardiac rehabilitation

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Published Papers (5 papers)

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Research

Jump to: Review

14 pages, 946 KB  
Article
ChatGPT’s Limitations in Athlete ECG Interpretation: Evidence from a Multicenter Diagnostic Study
by Stefano Palermi, Marco Vecchiato, Tommaso Remo Iacovone, Matteo Anselmino, Rachele Adorisio, Alessandro Biffi, Francesco Borrelli, Erica Brugin, Nicoletta Cantarutti, Elena Cavarretta, Mattia Cominacini, Marco Corsi, Flavio D’Ascenzi, Vittorio De Feo, Giuseppe Di Gioia, Gianluigi Dorelli, Giulia Foccardi, Sabina Gallina, Silvia Giangrandi, Francesca Graziano, Elisa Lodi, Alberto Livio, Viviana Maestrini, Guglielmo Leonardo Manfredi, Davide Mansour, Maria Grazia Modena, Daniel Neunhaeuserer, Antonia Nigro, Andrea Palermi, Alessio Pellegrino, Antonio Pelliccia, Filippo Maria Quattrini, Fabrizio Ricci, Fiammetta Scarzella, Maria Rosaria Squeo, Riccardo Tonelli, Emanuele Zanardo, Alessandro Zorzi, Fabrizio D’Ascenzo, Gaetano Maria De Ferrari and Andrea Sagliettoadd Show full author list remove Hide full author list
J. Cardiovasc. Dev. Dis. 2026, 13(5), 191; https://doi.org/10.3390/jcdd13050191 - 29 Apr 2026
Viewed by 675
Abstract
Background: Artificial intelligence (AI) has shown promise in the interpretation of electrocardiograms (ECGs) using signal-based deep learning models. In parallel, large language models (LLMs) have gained increasing visibility in clinical practice, including exploratory applications in ECG analysis. Whether a general-purpose LLM can meaningfully [...] Read more.
Background: Artificial intelligence (AI) has shown promise in the interpretation of electrocardiograms (ECGs) using signal-based deep learning models. In parallel, large language models (LLMs) have gained increasing visibility in clinical practice, including exploratory applications in ECG analysis. Whether a general-purpose LLM can meaningfully discriminate cardiovascular disease from athlete ECGs during PPS remains unknown. We aimed to evaluate the diagnostic performance of a general-purpose LLM for this task. Methods: In this multicentre diagnostic accuracy study, we evaluated a commercially available LLM (ChatGPT, version 5) in 2950 competitive athletes undergoing PPS. All athletes underwent resting 12-lead ECG, with second- and third-line investigations performed when clinically indicated. The reference outcome was confirmed cardiovascular disease after full diagnostic work-up (n = 450, 15.3%). For each ECG, the LLM generated a numeric score (0–100) representing the inferred likelihood of underlying disease using a standardized prompt and without task-specific fine-tuning. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis. Misclassification patterns were analysed according to International ECG Criteria. Results: GPT-derived scores demonstrated a marked floor effect, with a median value of 0 (IQR 0–2) in both diseased and non-diseased athletes and substantial overlap between groups. The area under the ROC curve was 0.52 (95% CI 0.49–0.55), indicating performance close to random classification. At the Youden-derived threshold, 79% of athletes with confirmed disease were incorrectly classified as negative. False-negative cases were predominantly characterized by borderline ECG patterns (82%), and a substantial number of red-flag ECG abnormalities were also missed. Conclusions: In this PPS cohort, a general-purpose LLM used in a naïve configuration showed no clinically meaningful ability to discriminate between cardiovascular disease and athlete ECGs. Without task-specific training or domain adaptation, such models should not be used for diagnostic triage in athlete screening. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise, 2nd Edition)
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17 pages, 648 KB  
Article
Sporting Careers After ICD Implantation in Elite Athletes
by Marco Vecchiato, Florian Egger and Stefano Palermi
J. Cardiovasc. Dev. Dis. 2026, 13(2), 97; https://doi.org/10.3390/jcdd13020097 - 17 Feb 2026
Viewed by 958
Abstract
Background: The use of implantable cardioverter defibrillators (ICDs) in elite athletes following sudden cardiac arrest (SCA) or the diagnosis of high-risk cardiac conditions presents a complex interplay of medical, psychological, and legal challenges. Despite evolving guidelines, data on clinical outcomes and return-to-sport (RTS) [...] Read more.
Background: The use of implantable cardioverter defibrillators (ICDs) in elite athletes following sudden cardiac arrest (SCA) or the diagnosis of high-risk cardiac conditions presents a complex interplay of medical, psychological, and legal challenges. Despite evolving guidelines, data on clinical outcomes and return-to-sport (RTS) trajectories in elite athletes remain limited. Objective: To describe the clinical profiles, management strategies, and career outcomes of elite athletes who received ICDs. Methods: A retrospective multilingual media and literature search was performed up to January 2026 to identify elite athletes with ICDs. Inclusion criteria required evidence of professional or Olympic-level competition, confirmed ICD implantation, and sufficient clinical and career data. Cases were analyzed for demographics, underlying diagnosis, prevention type, post-ICD outcomes, and RTS status. Results: Thirty-seven elite athletes were identified (mean age 25.8 ± 4.3 years). The most common sport was football (n = 25). Hypertrophic cardiomyopathy, non-ischemic LV scar, and arrhythmogenic cardiomyopathy were the most frequent diagnoses, although 49% of etiologies remained unspecified. ICDs were implanted for secondary prevention in 70% of cases. Following ICD implantation, 25 athletes (68%) completed RTS, including 24 (65%) at the professional level. Among these, nine experienced shocks, and four ultimately discontinued competition. The sole fatality occurred in an athlete who had voluntarily explanted the ICD. Conclusions: A substantial proportion of elite athletes with ICDs successfully return to high-level sport, but clinical outcomes, risk tolerance, and legal frameworks remain variable. These findings support continued shifts towards personalized shared decision making and highlight the need for standardized, sport-specific RTS protocols, long-term registries, and psychosocial support in this population. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise, 2nd Edition)
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19 pages, 2334 KB  
Article
Phenotyping the Structure and Function of the Heart of Elite Sailors: Implications for Pre-Participation Cardiac Screening
by Joseph D. Maxwell, Luca J. Howard, Ian White, Florence Place, Obipiseibima Aggokabo, Shaun Robinson, Camille S. L. Galloway, Jacob K. K. Shardey, Christian Verrinder, Keith P. George, Robert Cooper and David Oxborough
J. Cardiovasc. Dev. Dis. 2026, 13(1), 53; https://doi.org/10.3390/jcdd13010053 - 20 Jan 2026
Viewed by 619
Abstract
Background: Structural and functional adaptation of the heart to chronic exercise is dependent on multiple factors, including the volume and type of training, and has direct implications for pre-participation cardiac screening (PPCS). Sailing is a unique multi-training modality sport with limited prior description [...] Read more.
Background: Structural and functional adaptation of the heart to chronic exercise is dependent on multiple factors, including the volume and type of training, and has direct implications for pre-participation cardiac screening (PPCS). Sailing is a unique multi-training modality sport with limited prior description of cardiac adaptation to training. The aims of this study are (1) to describe electrocardiogram (ECG) changes in sailors, informing PPCS guidelines; (2) to assess structural and functional cardiac changes in sailors; and (3) to examine sex- or discipline-specific cardiac adaptations in sailors. Methods: Seventy elite sailors (33 females) underwent standard ECG and echocardiography. Echocardiographic data were compared to population norms and analysed by sex and sailing discipline based on training type: isometric (IG), pumping (PG), and movement (MG). Results: One sailor presented with abnormal ECG findings (T wave inversion) which warranted further investigation. Primary training-related ECG changes noted were early repolarisation (24%) and sinus bradycardia (30%). The left ventricular volume index was dilated in 18% of all sailors compared to reference values, with similar findings noted on right ventricular parameters for 22% of the study population, although in males only. The impact of predominant training stimulus (IG, PG, MG) did not mediate differences in the structure of any cardiac chambers (p > 0.05). Ejection fraction was lower in the PG (Δ4%, p ≤ 0.001), whereas global longitudinal strain was higher (Δ2%, p = 0.02) compared to MG and IG. Conclusions: Elite-level sailors present with electrical and structural cardiac phenotypes associated with exercise adaptation, with dilation of both left- and right-sided chambers. These data should be considered when interpreting results of PPCS in male and female sailors from different, specific disciplines. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise, 2nd Edition)
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9 pages, 1207 KB  
Article
Hypertrabeculation in Olympic Athletes: Advanced LV Function Analysis by CMR
by Alessandro Spinelli, Sara Monosilio, Giuseppe Di Gioia, Gianni Pedrizzetti, Giovanni Tonti, Cosimo Damiano Daniello, Maria Rosaria Squeo, Antonio Pelliccia and Viviana Maestrini
J. Cardiovasc. Dev. Dis. 2025, 12(10), 388; https://doi.org/10.3390/jcdd12100388 - 2 Oct 2025
Viewed by 762
Abstract
Left ventricular (LV) hypertrabeculation is increasingly recognized as a phenotype that may reflect physiological adaptation, particularly in athletes exposed to chronic overload, although its functional relevance remains uncertain. This study evaluated the prevalence of excessive trabeculation and its physiological correlation with LV remodeling. [...] Read more.
Left ventricular (LV) hypertrabeculation is increasingly recognized as a phenotype that may reflect physiological adaptation, particularly in athletes exposed to chronic overload, although its functional relevance remains uncertain. This study evaluated the prevalence of excessive trabeculation and its physiological correlation with LV remodeling. We conducted a single-center, cross-sectional study involving 320 Olympic-level athletes without cardiovascular disease. All underwent cardiac magnetic resonance (CMR). Hypertrabeculation was defined by the Petersen criteria. Athletes meeting these criteria were classified as hypertrabeculated and compared with non-hypertrabeculated matched for age, sex, and sport category. LV morphology, function, strain parameters, and hemodynamic forces (HDFs) were analyzed. Hypertrabeculation was identified in 9% of the cohort. No significant differences were observed between groups for training exposure (p = 0.262), body surface area (p = 0.762), LV volumes (end-diastolic volume indexed p = 0.397 end-systolic volume indexed p = 0.118), ejection fraction (p = 0.101), mass (p = 0.919), sphericity index (p = 0.419), myocardial wall thickness (p = 0.394), tissue characterization (T1 mapping p = 0.366, T2 mapping p = 0.833), global longitudinal strain (GLS p = 0.898), global circumferential strain (GCS p = 0.219), or HDFs. All values were within the normal range. In our cohort, LV hypertrabeculation, evaluated by CMR, was relatively common but not associated with structural or functional abnormalities, supporting its interpretation as a benign variant in asymptomatic athletes with normal cardiac function. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise, 2nd Edition)
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Review

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14 pages, 448 KB  
Review
Ventricular Repolarization Abnormalities in Pediatric Athletes: A Practical Approach to Clinical Evaluation
by Lorenzo Morra, Riccardo Borzuola, Antonio Gianfelici, Francesco Nifosì, Federico Quaranta, Leonardo Calò, Fabio Pigozzi and Chiara Fossati
J. Cardiovasc. Dev. Dis. 2026, 13(5), 185; https://doi.org/10.3390/jcdd13050185 - 28 Apr 2026
Viewed by 232
Abstract
Ventricular repolarization abnormalities are among the most frequent electrocardiographic findings in pediatric athletes undergoing cardiovascular screening, yet their clinical significance remains a major source of diagnostic uncertainty. While most of them represent benign expressions of training-induced cardiac remodeling and developmental maturation, selected patterns [...] Read more.
Ventricular repolarization abnormalities are among the most frequent electrocardiographic findings in pediatric athletes undergoing cardiovascular screening, yet their clinical significance remains a major source of diagnostic uncertainty. While most of them represent benign expressions of training-induced cardiac remodeling and developmental maturation, selected patterns may constitute the earliest phenotypic manifestation of cardiomyopathies or primary electrical disease. Distinguishing physiological adaptation from early pathology is therefore essential to prevent both sudden cardiac events and unnecessary restrictions on sports participation. This review integrates contemporary international electrocardiographic interpretation criteria with emerging pediatric evidence to provide a clinically oriented framework for evaluation and risk stratification of ventricular repolarization abnormalities in pediatric athletes. Early repolarization and anterior T-wave inversion are commonly benign when occurring within recognized age- and ethnicity-specific patterns and in the absence of symptoms, concerning family history, or structural abnormalities. Conversely, lateral or inferolateral T-wave inversion, atypical ST-segment morphology, complex ventricular arrhythmias, and abnormal imaging findings represent red flags requiring comprehensive investigation, including multimodality imaging when indicated. Due to the dynamic electrophysiological evolution during adolescence, longitudinal reassessment is crucial. A structured, risk-based approach integrating electrocardiographic features, demographic/familial context, clinical evaluation, imaging findings, and follow-up provides a pragmatic strategy to optimize risk detection while safeguarding appropriate athletic participation in young athletes. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise, 2nd Edition)
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