ReviewWhat May the Future Hold for Sports Cardiology?
Introduction
Cardiology is a unique specialty within internal medicine, in that it uses exercise as part of both the diagnosis and treatment of disease. The effect of exercise on cardiovascular function has long been a consideration in medicine but the sub-specialty of sports cardiology represents a relatively new discipline focussing on the clinical issues pertaining to athletes and exercise enthusiasts. The dominant topics of concern have related to the identification of structural heart disease and the management of cardiac arrhythmias, mainly aimed at prevention of sudden cardiac death and deterioration of cardiovascular function. Intense debate has surrounded the issue of pre-participation screening of athletes and this has dominated much of the sports cardiology agenda over the recent decade. The aim of this commentary is to reflect upon the current topics of interest in sports cardiology and to identify unresolved issues that are likely to receive attention in the decades to come.
Section snippets
What Is an Athlete?
In a field devoted to understanding cardiovascular adaptation and pathology in athletic individuals, it is remarkable that there is no standardised definition of what constitutes an “athlete”. The Bethesda guidelines have provided the best current definition of an athlete: “One who participates in an organized team or individual sport that requires regular competition against others as a central component, places a high premium on excellence and achievement, and requires some form of systematic
Pre-Participation Screening of Athletes, What Comes Next?
There has been considerable debate about the merits and concerns of including an electrocardiogram (ECG) in pre-participation screening of athletes highlighting the fact that a majority of causes of sudden cardiac death (SCD) in athletes are associated with electrocardiographic abnormalities that may lead to early treatment and preventative strategies [3]. On the other hand, it has been argued that the imperfect specificity of electrocardiographic testing when screening for rare conditions
Pathological Versus Physiological Remodelling
The sports cardiology literature is filled with studies that seek to discriminate healthy physiological athletic remodelling of the myocardium from pathological remodelling due to inherited cardiomyopathies, hypertensive or valvular heart disease. In a recent review, Nakamura and Sadoshima encapsulate the discussions of hundreds of articles in stating: “There are two types of hypertrophy: physiological and pathological” [11]. However, this orthodox view is being challenged in sports cardiology
A Shift Away From Comparing Diseased Cohorts to Athletes
There have been significant errors in the conclusions drawn from studies that have compared cohorts of patients with cardiac pathology with healthy athletes. Maron and Pelliccia have, perhaps, contributed more to the field of sports cardiology than any other investigators but their instructions on how to distinguish the athlete with borderline hypertrophy from the patient with hypertrophic cardiomyopathy (HCM) have recently been questioned. They suggested that cardiopulmonary fitness, diastolic
Towards a Specific Ethical Framework
When discussing ethics in sports, one usually focusses on the aspect of performance-enhancing drug intake, mainly pointing to the responsibility of the athletes themselves. In line with the previous paragraphs, the field of sports cardiology must address other important aspects. One is to define the boundaries of ‘professional training guidance’: even without considering drugs, we need to study other measures that optimise performance such as low-pressure chambers, high-altitude training,
A Need for Prospective Research
The field of sports cardiology is filled with cross-sectional observations of associations between exercise and changes in cardiac function and remodelling. This brings the potential for errors in assuming a causal relationship exists between phenomena. For example, it is often assumed that exercise is the cause of the enlarged hearts observed in athletes, but it is also possible that people with larger hearts are more likely to be successful athletes. The few examples of well-conducted
Conclusion
We have highlighted some of the current barriers to knowledge advancement in the understanding of the interaction between exercise and cardiovascular adaptation. The effect of exercise on the heart, vessels and metabolism can be profound and is an under-utilised model of discovery. The future is bright, and we look forward to showcasing evolving discoveries at future editions of the Baker Sports Cardiology symposia and in Heart Lung and Circulation.
Acknowledgements
The research being undertaken by the authors into the mechanisms of AF in athletes is funded by NHMRC project grant: APP1130353 Atrial remodelling and risk of arrhythmias in endurance athletes. A/Prof La Gerche is supported by a Career Development Fellowship from the National Health and Medical Research Council (NHMRC 1089039) and a Future Leaders Fellowship from the National Heart Foundation (NHF 100409) of Australia.
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