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Myocarditis in athletes: Challenges for return to play
Hélder Dores1, Paulo Dinis2, Luís Puga3
1Department of Cardiology, Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CHRC, Comprehensive Health Research Center; Associate Laboratory REAL (LA-REAL), Lisbon, Portugal; Health and Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal; Centro de Medicina Desportiva de Lisboa, Lisbon, Portugal.
Insights
Myocarditis diagnosis is complex, requiring multidisciplinary evaluation. This review focuses on managing myocarditis in athletes and the challenges of return-to-play decisions for athlete safety.
Area of Science:
- Cardiology
- Sports Medicine
Background:
- Myocarditis presents with diverse causes and outcomes, making diagnosis difficult.
- It is a significant cause of sudden cardiac death in young athletes.
- Current diagnostic approaches integrate clinical assessment, biomarkers, and advanced imaging.
Purpose of the Study:
- To review the management of myocarditis in athletes.
- To address the complexities of return-to-play decisions after myocarditis.
Main Methods:
- Review of current literature on myocarditis diagnosis and management.
- Emphasis on cardiac magnetic resonance and endomyocardial biopsy as diagnostic cornerstones.
- Discussion of risk stratification strategies for athletes.
Main Results:
- Cardiac MRI is the non-invasive gold standard for myocarditis diagnosis.
- Return-to-play decisions in athletes are challenging due to limited evidence.
- Multifaceted evaluation is crucial for athlete safety.
Conclusions:
- A multidisciplinary approach is essential for diagnosing and managing myocarditis.
- Careful risk stratification and shared decision-making are vital for safe return-to-play in athletes.
- Further evidence-based data is needed to guide return-to-play protocols.
Abstract:
Myocarditis is a condition characterized by heterogeneous etiologies, clinical manifestations, and natural history. Its diagnosis remains challenging and requires a multidisciplinary approach that integrates clinical evaluation, biomarkers, electrocardiography, echocardiography, and advanced imaging modalities. Cardiac magnetic resonance has emerged as the non-invasive gold-standard test that together with endomyocardial biopsy, constitutes the foundation of the current diagnostic classification. Myocarditis is also a frequent acquired cause of sudden cardiac death in young individuals, including athletes. In this setting, the evaluation of return-to-play eligibility in athletes after acute myocarditis is complex and often limited by scarce evidence-based data. Accurate risk stratification, guided by a comprehensive multiparametric evaluation and a shared decision-making process that considers the potential risks of resuming competitive sport, is fundamental to ensuring athlete safety. This review aims to discuss the management of athletes with myocarditis and to address the challenges associated with return-to-play decisions.
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