Focus on Sports Cardiology : The complete series of recommendations are now freely accessible.

Dr. Hans Bjornstad

The field of Sports Cardiology has a long history within the European Society of Cardiology (ESC), being a topic of  the first Working Group (WG I: Exercise physiology, physiopathology and stress testing). It was founded in 1982, the first chairmen being Bruno Carù,  Italy and Henry Detry, Belgium. From 1994  WG I also included  WG of Rehabilitation , and in 2002 a Study Group of Sports Cardiology was formed within WG1. In 2005 the WG1 joined WG 13 (Epidemiology and Prevention) to form the European Association for Cardiovascular Prevention and Rehabilitation  (EACPR), and from  2006 Sports Cardiology  has been a formal section of the EACPR (present Chairman Mats Børjesson). The fusion was a natural step, as the European Journal of Cardiovascular Prevention and Rehabilitation (EJCPR)  was already launched in 2003, with Sports Cardiology as one of its topics.

The first purpose of the Sports Cardiology group was to reach a large European consensus regarding two controversial issues: i.e., the most appropriate protocol of preparticipation screening to prevent sudden death in competitive athletes and the recommendations  to advise participation in competitive sport in individuals with cardiovascular disease. The existing Bethesda Guidelines (1) were several years old, and in the complete absence of European guidelines, it was a timely  effort of the Sports Cardiology to publish the consensus documents in this field "Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol" (2) and "Recommendations for competitive sports participation in athletes with cardiovascular disease" (3). Formally this project was initiated by WG1 , and formal representatives from the following ESC  Working Groups also cooperated on the Recommendations: Arrhythmia, Grown-up Congenital Heart Disease, Coronary Circulation, Hypertension and the Heart, Myocardial and Pericardial Diseases  and Valvular Heart Disease. This was done in  agreement with the ESC Committee for Practice Guidelines. Thus the recommendations  are approved officially by ESC.

There is solid scientific documentation that  sports activity  may induce sudden death in young athletes (4) and that the screening program proposed is efficient in counteracting this (2,5). Therefore, the acceptance of the  ESC proposal by the International Olympic Committee (IOC)  also presented in our Journal (6)  was important.

The other  big issue of the Sports Cardiology study Group was giving recommendations in athletes with known heart disease  presented as an article in the European Heart Journal(3). Subtopics of this article later was extended to 7 articles in the EJCPR ,which can now be freely downloaded . In the first article on hypertension, Fagard et al (7) give risk stratification in hypertension and advice for top athletes as well as recreational sporters. Generally, dynamic sports activities are recommended, but also low-to moderate strength training  is not harmful and may even contribute to blood pressure control.(8) Although regular exercisers enjoy a reduced risk of cardiovascular events, the risk of acute myocardial infarction and sudden death increase transiently during strenuous physical exertion(9). How to estimate  and reduce this risk in  top athletic and leisure time sport activity is focussed  by Børjesson (10). Recommendations for participation in leisure-time physical activity in patients with arrhythmias and potentially arrhythmogenic conditions are presented by Heidbuchel et al both for supraventricular arrhythmias and pacemakers (11) and ventricular arrhythmias(12), by Pelliccia et al in individuals with cardiomyopathies,myocarditis and pericarditis (13), by Mellwig et al in valvular heart disease (14), and by Hirth et al in congenital heart disease (15).

Finally, Deligiannis et al (16) present a position paper on adverse cardiovascular effects of doping in athletes, aiming to inform physicians, trainers and athletes  and to discourage individuals from using drugs during sports. We think that making all these articles freely accessible will be an important preventive tool, and also increasing the interest in the field of Sports Cardiology and the visibility of the EJCPR.We also think that it will encourage an  increasing number of authors to submit on this topic, leading to an even higher visibility of this crucial issue and contributing to raising the scientific level of the Journal.

Hans Bjørnstad,MD PhD
Consultant of cardiology, Haueland University Hospital, Bergen, Norway
(Ass.Editor EJCPR and previous chairman of WG I and Study Group of Sports Cardiology) 

References: 

1.    26^th Bethesda Conference:recommendations for determining eligibility for competition athletes with cardiovascular abnormalities. January 6-7,1994 (Chairman Maron BJ). J Am Coll Cardiol 1994; 24: 845-899

2.Corrado D, Pelliccia A, Bjørnstad HH,  Vanhees L, Biffi A, Børjesson M ,Panhuyzen-Goedkoop N, Deligiannis A, Solberg EE, Dugmore D, Mellwig KP, Asanelli D, Delise P, van Buuren F, Anastakis A, Heidbuchel H, Hoffmannn E, Fagard R, Priori SG,  Basso C, Arbustini E, Blomstrøm-Lundquist C, McKenna W,Thiene G: Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Eur Heart J 2005; 26:516-524

3.Pelliccia A, Fagard R, Bjørnstad HH, Anastakis A, Arbustini E, Assanelli D, Biffi A, Børjesson M, Carre F, Corado D, Delise P, Dorwarth U, Hirth A, Heidbuchel H, Hoffmann Ellen, Mellwig KP, Panhuyzen-Godkoop N, Pisani A, Solberg EE, vanBuuren F,Vanhees L.(Reviewing committee: Blom strøm-Lundquist C,Deligiannis A,Dugmore D, Glikson M,Hoff PI, Hoffmann A,Hofmann Erik, Horstkotte D, Nordrehaug JE, Oudhof J, McKenna WJ, Penco M, Priori S, Reybrouk T, Senden J, Spataro A,Thiene G.): Recommendations for competitive sports participation in athletes with cardiovascular disease. Eur Heart J 2005; 26:1422-1445

4.Corrado D,Basso C, Rizzoli C, Schiavon M, Thiene G.Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 2003; 42:1959-1963

5.Corrado D, Basso C, Pavei A, Michieli P, Schiavon M,Gaetano T.Trends in sudden  cardiovascular death in young competetive athletes after implementation of a preparticipation screening program. JAMA 2006; 296:1593-1601.

6.Bille K,Schamasch P, Figoeiras D, Brenner JI, Kappenberger L, Meijboom FJ, Meijboom EJ.Sudden cardiac death in athletes: The Lausanne Recommendations. Eur J Cardiovasc Prev Rehabil 2006;13:859-875

7. Fagard RH. Eur J Cardiovasc Prev Rehab 2005;12:326-331

8. Cornelissen VA,Fagard RH. Effects of restistance training on resting blood pressure:A meta-analysis  of randomized controlled trials. J Hypertens 2005; 23:251-258

9.Mittleman MA.Triggers of acute cardiac events: New insights. Am J Med Sports 2002;4:99-102.

10.Børjesson M et al. Eur J Cardiovac Prev Rehab 2006;13:137-149

11.Heidbuchel H. Eur J Cardiovasc Prev Rehab 2006;13:676-686

12.Heidbuchel H. Eur J Cardiovasc Prev Rehab 2006;13:475-484

13.Pelliccia A. Eur J Cardiovasc Prev Rehab 2006;13:976-885

14.Mellwig K-P. Eur J Cardiovasc Prev Rehab 2008;15:95-103

15. Hirth A. Eur J Cardiovasc Prev Rehab 2006;13:293-299

16.Deligiannis A. Eur J Cardiovasc Prev Rehab 2006;13:687-694