Myocarditis and sports in the young: data from a nationwide registry on myocarditis-"MYKKE-Sport"

Isabelle Schöffl; Sophia Holler; Sven Dittrich; Thomas Pickardt; Bernd Opgen-Rhein; Martin Boehne; Bardo Wannenmacher; Katja Reineke; Gesa Wiegand; Tobias Hecht; Michael Kaestner; Daniel Messroghli; Stephan Schubert; Franziska Seidel; Annika Weigelt

doi:10.3389/fspor.2023.1197640

Myocarditis and sports in the young: data from a nationwide registry on myocarditis-"MYKKE-Sport"

Front Sports Act Living. 2023 Jun 26:5:1197640. doi: 10.3389/fspor.2023.1197640. eCollection 2023.

Authors

Isabelle Schöffl^{1

2}, Sophia Holler¹, Sven Dittrich¹, Thomas Pickardt³, Bernd Opgen-Rhein⁴, Martin Boehne⁵, Bardo Wannenmacher⁶, Katja Reineke⁷, Gesa Wiegand⁸, Tobias Hecht⁹, Michael Kaestner¹⁰, Daniel Messroghli^{11

12

13}, Stephan Schubert^{9

13

14}, Franziska Seidel^{4

13

14

15

16}, Annika Weigelt¹

Affiliations

¹ Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany.
² School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, Great Britain.
³ Competence Network for Congenital Heart Defects, Berlin, Germany.
⁴ Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
⁵ Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
⁶ Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany.
⁷ Department for Paediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany.
⁸ Department for Paediatric Cardiology, University Hospital Tübingen, Tübingen, Germany.
⁹ Heart- and Diabetes Center North Rhine-Westphalia, Center of Pediatric Cardiology and Congenital Heart Disease, Ruhr University Bochum, Bad Oeynhausen, Germany.
¹⁰ Pediatric Cardiology, University Hospital Ulm, Ulm, Germany.
¹¹ Department of Cardiology, German Heart Center Berlin, Berlin, Germany.
¹² Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany.
¹³ German Centre for Cardiovascular Research, Berlin, Germany.
¹⁴ Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.
¹⁵ Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁶ Experimental and Clinical Research Center, A Cooperation Between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Background: Myocarditis represents one of the most common causes of Sudden Cardiac Death in children. Myocardial involvement during a viral infection is believed to be higher as a consequence of intensive exertion. Recommendations for return to sports are based on cohort and case studies only. This study aims to investigate the relationship between physical activity and myocarditis in the young.

Patient: Every patient in the MYKKE registry fulfilling criteria for suspicion of myocarditis was sent a questionnaire regarding the physical activity before, during and after the onset of myocarditis.

Method: This study is a subproject within the MYKKE registry, a multicenter registry for children and adolescents with suspected myocarditis. The observation period for this analysis was 93 months (September 2013-June 2021). Anamnestic, cardiac magnetic resonance images, echocardiography, biopsy and laboratory records from every patient were retrieved from the MYKKE registry database.

Results: 58 patients (mean age 14.6 years) were enrolled from 10 centers. Most patients participated in curricular physical activity and 36% in competitive sports before the onset of myocarditis. There was no significant difference of heart function at admission between the physically active and inactive subjects (ejection fraction of 51.8 ± 8.6% for the active group vs. 54.4 ± 7.7% for the inactive group). The recommendations regarding the return to sports varied widely and followed current guidelines in 45%. Most patients did not receive an exercise test before returning to sports.

Conclusion: Sports before the onset of myocarditis was not associated with a more severe outcome. There is still a discrepancy between current literature and actual recommendations given by health care providers. The fact that most participants did not receive an exercise test before being cleared for sports represents a serious omission.

Keywords: cardiomyopathy; heart muscle infection; prevention; return to sports; sudden cardiac death.

Grants and funding

This work was supported by the German Heart Foundation (September 2013 to June 2021). The pilot phase and scientific planning of the MYKKE registry was supported by two project grants from Deutsche Herzstiftung (Frankfurt am Main, Germany). Since February 2017 MYKKE has been funded by kinderherzen—Fördergemeinschaft Deutsche Kinderherzzentren e.V. (Bonn, Germany). Logistic support and management of the research database are provided by the Competence Network for Congenital Heart Defects (Berlin, Germany), which received funding from the Federal Ministry of Education and Research, grant number 01GI0601 (until 2014), and the DZHK (German Centre for Cardiovascular Research) as of 2015.