Thorac Cardiovasc Surg 2022; 70(S 02): S67-S103
DOI: 10.1055/s-0042-1743016
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Myocarditis and Sports: Data from a Nationwide Registry on Myocarditis: “MYKKE-Sport”

I. Schöffl
1   Universitätsklinikum Erlangen, Kinderkardiologische Abteilung, Erlangen, Deutschland
,
S. Holler
2   Kinderkardiologische abteilung, University of Erlangen-Nuremberg, Erlangen, Deutschland
,
S. Dittrich
3   Kinderkardiologische abteilung, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schloßplatz, Erlangen, Germany, Erlangen, Deutschland
,
F. Seidel
4   Pediatric Cardiology, German Heart Institute Berlin, Berlin, Deutschland
,
P. Thomas
5   Kompetenznetz Angeborene Herzfehler, Berlin, Deutschland
,
M. Kaestner
6   University Hospital Ulm, Ulm, Deutschland
,
B. Opgen-Rhein
7   Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
,
M. Böhne
8   Pediatric Cardiology, Medizinische Hochschule Hannover, Hannover, Deutschland
,
B. Wannenmacher
9   Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
,
K. Reineker
10   Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Centre Freiburg - Bad Krozingen, Medical Centre-University of Freiburg, Freiburg, Deutschland
,
G. Wiegand
11   Department of Pediatric Cardiology, University of Tuebingen, Tuebingen, Deutschland
,
A. Rentzsch
12   Pediatric Cardiology, Universitätsklinikum des Saarlandes, Homburg, Deutschland
,
A. Weigelt
13   Kinderkardiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
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Background: Myocarditis is considered to be the most common cause of sudden cardiac death (SCD) in children in Denmark and Germany. In animal models, myocardial involvement during viral infections has been shown to be higher due to intensive exertions. Recommendations for return to training are based on cohort and case studies. Recommendation includes return to sports after 3 to 6 months after onset of myocarditis. Still, the restrictions chosen by the medical community vary leading to poor compliance and possible consequences if not adhered to. This registry study aims at investigating the relationship between physical activity and myocarditis in the young.

Method: This study is a subproject of the MYKKE registry, a German multicenter registry for children with suspected myocarditis. The observation period for this analysis was 93 months (September 2013–June 2021). Patients from the MYKKE registry meeting a few criteria, such as biopsy-proven myocarditis, myocarditis diagnosed in CMR, positive cardiac biomarker, or ECG abnormalities, were enrolled and sent a questionnaire regarding physical activity before, during, and after the onset of myocarditis. The recommendations for return to sports were investigated. Anamnestic, cardiac MRI, echocardiography, biopsy, and laboratory records from every patient were retrieved from the MYKKE registry database.

Results: Fifty-eight patients (average age: 14.6 years) from nine centers participated, 65.5% of them were male. Most patients (84.5%) participated in curricular physical activity and 36% in competitive sports 6 months prior to the onset of myocarditis. There was no difference of heart function between the physically active and inactive patients. Most participants (60.3%) observed symptoms of an infectious disease in the 2 weeks leading to the myocarditis. Continuing with physical activity, despite these symptoms, did not lead to a worse outcome. The recommendations regarding the return to sports varied widely and followed current guidelines in merely 45%. Most patients (84.5%) did not receive an exercise test before returning to sports.

Conclusion: As observed previously, predominantly adolescent males were participated. Physical activity before the onset of myocarditis was not associated with a more severe outcome. There is still a discrepancy between current guidelines and the actual recommendations provided by health care providers. Especially the fact that only a minority of patients received the recommended exercise test before returning to sports is worrying, given the fact that malignant arrhythmias must be ruled out.



Publication History

Article published online:
12 February 2022

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