Key result
Proposed return-to-play algorithm incorporates CMR and shared decision-making for athletes recovering from myocarditis.
Why the study?
Athletes face risks such as sudden cardiac death after myocarditis, but knowledge gaps persist regarding the optimal duration of exercise restriction and the implications of persistent late gadolinium enhancement on CMR.
This review highlights the importance of CMR and shared decision-making in guiding return-to-play for athletes recovering from myocarditis.
May inform return-to-play protocols for athletes post-myocarditis using CMR and shared decision-making; leaves open prospective validation.
Myocarditis is a condition marked by inflammation of the heart muscle, which can lead to serious outcomes such as sudden cardiac death (SCD) and life-threatening arrhythmias. While myocarditis can affect any population, athletes, especially those engaged in high-intensity training, are at increased risk due to factors such as reduced immunity and increased exposure to pathogens. This review examines the clinical presentation, current guidelines, diagnostic challenges, and the significance of cardiac magnetic resonance imaging (CMR) in detecting myocardial inflammation and scarring. Current guidelines recommend a period of exercise restriction followed by thorough reassessment before athletes can return-to-play (RTP). However, there are several knowledge gaps, including the implications of persistent late gadolinium enhancement (LGE) on CMR and the optimal duration of exercise restriction. Additionally, the psychological impact of myocarditis on athletes highlights the importance of incorporating mental health support in the recovery process. A shared decision-making approach should be encouraged in RTP, considering the athlete's overall health, personal preferences, and the potential risks of resuming competitive sports. We have proposed an algorithm for RTP in athletes following myocarditis, incorporating CMR. Future research is warranted to refine RTP protocols and improve risk stratification, particularly through longitudinal studies that examine recovery and outcomes in athletes.
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Yamagata et al. (2024) conducted a review in Myocarditis. Return-to-play protocols was evaluated. A proposed return-to-play algorithm incorporates cardiac magnetic resonance imaging and shared decision-making to guide athletes recovering from myocarditis.
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