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. 2023 Jun 26:5:1197640.
doi: 10.3389/fspor.2023.1197640. eCollection 2023.

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

Isabelle Schöffl  1   2 , Sophia Holler  1 , Sven Dittrich  1 , Thomas Pickardt  3 , Bernd Opgen-Rhein  4 , Martin Boehne  5 , Bardo Wannenmacher  6 , Katja Reineke  7 , Gesa Wiegand  8 , Tobias Hecht  9 , Michael Kaestner  10 , Daniel Messroghli  11   12   13 , Stephan Schubert  9   13   14 , Franziska Seidel  4   13   14   15   16 , Annika Weigelt  1
Affiliations

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

Isabelle Schöffl et al. Front Sports Act Living. .

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.

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Conflict of interest statement

The reviewer LF declared a shared affiliation with the author(s) IS, SH, SD to the handling editor at the time of review. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The different types of extracurricular physical activities performed by the subjects before the onset of myocarditis (in %).
Figure 2
Figure 2
The frequency of symptoms reported by the subjects 2 weeks prior to the onset of myocarditis. Where subjects reported of more than one symptom, the more severe was listed (fever > sore throat or diarrhea > runny nose > unspecific symtpoms).
Figure 3
Figure 3
The rest periods recommended by the health care providers in %.
See this image and copyright information in PMC

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