Prolonged and intensive exercise induces remodeling of all four cardiac chambers, a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation, however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated, arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden cardiac death. Cardiac magnetic resonance (CMR) is a well-suited, highly reproducible imaging modality that can help differentiate athlete’s heart from cardiomyopathy. CMR allows accurate characterization of the morphology and function of cardiac chambers, providing full coverage of the ventricles. Moreover, it permits an in-depth understanding of the myocardial changes through specific techniques such as mapping or late gadolinium enhancement. In this narrative review, we will focus on the certainties and uncertainties of the role of CMR in sports cardiology. The main aspects of physiological adaptation due to regular and intensive sports activity and the application of CMR in highly trained athletes will be summarized.

At the pandemic's beginning, significant concern has risen about the prevalence of myocardial involvement after SARS‐CoV‐2 infection. We assessed the cardiovascular burden of SARS‐CoV‐2 in a large cohort of athletes and identified factors that might affect the disease course. We included 633 athletes in our study on whom we performed extensive cardiology examinations after recovering from SARS‐CoV‐2 infection. More than half of the athletes (n = 322) returned for a follow‐up examination median of 107 days after the commencement of their infection. Troponin T positivity was as low as 1.4% of the athletes, where the subsequently performed examinations did not show definitive, ongoing myocardial injury. Altogether, 31% of the athletes' rapid training rebuild was hindered by persistent or reoccurring symptoms. Female athletes reported a higher prevalence of return to play (RTP) symptoms than their male counterparts (34% vs. 19%, p = 0.005). The development of long COVID symptoms was independently predicted by increasing age and acute symptoms' severity in a multiple regression model (AUC 0.75, CI 0.685–0.801). Athletes presenting with either or both cough and ferritin levels higher than >150 μg/L had a 4.1x (CI 1.78–9.6, p = 0.001) higher odds ratio of developing persistent symptoms. While SARS‐CoV‐2 rarely affects the myocardium in athletes, about one in three of them experience symptoms beyond the acute phase. Identifying those athletes with a predisposition to developing long‐standing symptoms may aid clinicians and trainers in finding the optimal return‐to‐play timing and training load rebuild pace.

Body composition and cardiopulmonary exercise testing (CPET) are vital for optimizing sports performance, but the correlations between them are still underexplored. Our study aimed to investigate the relationships between body composition and specific CPET variables describing physical fitness in young athletes, also adjusting for age and height, in a less-studied, female population. Seventy players participated in our study (age: 16.10 ± 1.63 y). After determining body composition using dual-energy X-ray absorptiometry, we conducted treadmill-based maximal-intensity CPET. Data were analyzed in R using multivariate linear regression, accounting for age and height as confounders. Lean body mass (LBM), body fat mass (BFM), and bone mineral content (BMC) showed no effect on resting, maximum, or recovery heart rates and no correlation with resting or maximal lactate values. LBM positively correlated with maximum ventilation (VE-max) (Est: 1.3 × 10⁻³; SE: 6.1 × 10⁻⁴; p < 0.05) and maximum absolute oxygen consumption (VO2_abs-max) (Est: 7.710⁻⁵; SE: 6.9 × 10⁻⁶; p < 0.001)—with age as an influencing factor for VE-max and height as an influencing factor for VO2_abs-max. Conversely, BFM showed a negative correlation with maximum relative oxygen consumption (VO2_rel-max) (Est: −4.8 × 10⁻⁴; SE: 1.2 × 10⁻⁴; p < 0.001). Moreover, BFM and BMC were also negatively correlated with maximal exercise duration (Est: −2.2 × 10⁻⁴; SE: 8.0 × 10⁻⁵; p < 0.01; Est: −3.2 × 10⁻³; SE: 1.4 × 10⁻³; p < 0.05) with height as an influencing factor. Our findings indicate complex correlations between body composition and CPET parameters, providing important information for the analysis of individual ergospirometric data. Our results draw attention to the fact that body composition is more precise than weight and height in the evaluation of athletes’ physical fitness.

Mitral annular calcification (MAC) is usually considered an incidental, benign, age-related finding without serious complications in patients evaluated for cardiovascular or pulmonary disease with imaging studies that may result in mitral regurgitation or stenosis when severe. Therefore, it is usually not considered a significant alteration. However, there is accumulating evidence that it is associated with a higher risk of cardiovascular events, such as atherosclerotic coronary artery disease, aortic artery disease, carotid artery disease, peripheral artery disease, stroke, atrial fibrillation, atrioventricular and/or intraventricular conduction disturbance, systemic embolization, infective endocarditis, heart failure and mortality. The presence of MAC also significantly influences the outcome of mitral valve transcatheter and surgical interventions. Several conditions may predispose to MAC. MAC is strongly related to cardiovascular risk factors, such as hypertension, diabetes, smoking and cardiovascular atherosclerosis, and inflammation may also play a role in the pathogenesis of MAC. Also, conditions that increase mitral valve stress, such as hypertension, aortic stenosis and hypertrophic cardiomyopathy, predispose to accelerated degenerative calcification of the mitral annulus area. Congenital disorders, e.g., Marfan syndrome and Hurler syndrome, are also associated with MAC, due to an intrinsic abnormality of the connective tissue composing the annulus.

Background: Basic resting electrocardiographic changes caused by regular intense exercise are known characteristics of the athlete’s heart. Through detailed analysis of short-term ECG recordings, our aim was to study electrocardiographic, heart rate variability, and ventricular heterogeneity changes of the athlete’s heart as a function of factors influencing sports adaptation. Methods: Analysis of 1-minute resting lead I ECG recordings was used to determine standard ECG parameters, time-domain indicators of heart rate variability, and mean and standard deviation of QRST integrals. Statistical analysis was performed in Python development environment. Results: 500 healthy athletes (age: 19[16–24]y, male: 55%, training: 16.7 ± 6.5 h/w) were compared with 100 non-athlete controls (age: 21[17–23]y, male: 51%). Athletes had lower heart rate (68[61–78]vs.82[73–91]BPM, p < 0.001), increased p-wave amplitude (89[71–108]vs.80[62–96]µV, p < 0.001), PQ interval (152[140–168]vs.142[132–152]ms, p < 0.001), QRS width (90[82–100]vs.82[78–90]ms, p < 0.001), T-wave amplitude (257[198–311]vs.195[146–248]µV, p < 0.001), SDNN (64.7[47.2–87.2]vs.50.6[36.5–66.3]ms, p < 0.001), RMSSD (52.6[34.8–78.3]vs.36.4[26.8–52.6]ms, p < 0.001), pNN50 (31.1[12.7–50.9]vs.14.7[4.9–31.6]%, p < 0.001) and mean QRST integral (34.9[28.3–43.4]vs.26.1[19.7–33.9]mV*ms, p < 0.001) compared to controls. Mixed athletes had wider QRS compared to power athletes (94[90–102]vs.88[84–96]ms, p < 0.005). Male athletes had lower QTc, increased PQ interval, QRS width, T-wave amplitude, mean QRST integral, and its deviation. In the control group, females had higher resting heart rate and QTc duration, while AVNN and the relative deviation of QRST integral were lower. Many of the above parameters also showed weak correlation with age and weekly exercise hours. Conclusions: Our findings indicate that a 1-minute lead I ECG recording can detect electrical differences between athletes and non-athlete controls and may provide a practical framework for future longitudinal studies of athletic cardiac adaptation.

Pre-exercise carbohydrate intake is known to influence performance; however, data describing their effect on cardiorespiratory parameters is scarce. This study aimed to assess the effects of isotonic drink consumption on cardiopulmonary exercise test (CPET) parameters in elitemale youth basketball players. The athletes were randomized into a fasting (400 ml mineral water) and an isotonic drink (400 ml 7% isotonic solution) group respectively, and consumed the drinks 30 minutes before the CPET. Pre-, peak- and post-CPET glucose levels were measured. Borg and lactate were assessed every 2 minutes during the test. Seventy-one athletes (age: 15.9 ± 1.8 years) were included in the study. The isotonic drink group had higher pre- and post-CPET glucose levels (p < 0.05). They reported a lower Borg scale at the 2nd, 6th, and 10th minutes (p < 0.05), while their lactate levels were lower at the 14th minute (p < 0.05). Regression analysis showed that fasting was associated with higher Borg scale ratings (β-coefficient: 0.72, p < 0.001) and increased lactate accumulation over time (β-coefficient: 0.13, p = 0.01). No difference was found in exercise duration or maximal aerobic capacity. Single-dose isotonic drink consumption before CPET reduces perceived exertion and moderates lactate accumulation, which may suggest a beneficial effect during the exercise test.