Sportkardiologie 2021 – was gibt es Neues?

Was ist neu?

Sport bei kardiovaskulären Risikofaktoren und im Alter Falls Personen mit kardiovaskulären Risikofaktoren oder im Alter von ≥ 65 Jahren eine intensive sportliche Belastung planen, wird ihnen zur Risikominimierung des sportassoziierten plötzlichen Herztods eine kardiale Vorsorgeuntersuchung empfohlen. Zur individuellen Risikoeinordnung sollte beim Vorliegen von kardiovaskulären Risikofaktoren der ESC-Score Verwendung finden.

Sport bei kardiovaskulären Erkrankungen Die erstmalig erschienenen Leitlinien der European Society of Cardiology (ESC) „Sportkardiologie und körperliche Aktivität bei Patienten mit kardiovaskulärer Erkrankung“ (2020) [1] geben umfassende Trainingsempfehlungen zur Ausübung von Freizeit- und Leistungssport für Patienten mit kardiovaskulären Erkrankungen. Dabei ist eine kardiale Eingangsuntersuchung zur individuellen Risikostratifizierung als Basis der Trainingsberatung unumgänglich. Nur in Ausnahmefällen wird von einer sportlichen Betätigung (passager) abgeraten.

Sport, COVID-19 und Herz COVID-19 kann zu kardialen Schäden führen, wobei diese selten auch bei asymptomatischen und milden Krankheitsverläufen beobachtet wurden. Vor Wiederaufnahme intensiver sportlicher Aktivitäten sollte, in Abhängigkeit von Krankheitsschwere und Symptomatik, die Sporttauglichkeit überprüft und dann individuell das weitere Vorgehen bezüglich des Trainingsaufbaus festgelegt werden.

Abstract

The recently published guidelines “Sports cardiology and exercise in patients with cardiovascular disease” (2020) are the first of a kind by the European Society of Cardiology (ESC). The guidelines provide comprehensive training recommendations for patients with cardiovascular diseases or risk factors, covering the entire spectrum of cardiovascular diseases with case-specific recommendations for recreational and competitive sports.

The ESC recognizes exercise as an essential part of both prevention and therapy of cardiovascular diseases, that – comparable to drug therapies – requires correct prescription.

The initial cardiac examination is used for individual risk stratification and is indispensable for individualized training recommendations addressing training frequency, duration and intensity, as well as type of sport.

Thus, the question is not whether a patient with cardiovascular disease shall be allowed to exercise, but rather how he can safely perform it. Only in exceptional cases exercise therapy is (temporarily) contraindicated.

COVID-19 can lead to cardiovascular complications even in asymptomatic and mild disease courses. Before resuming intense sporting activities, different return-to-sports protocols have been introduced. The current consensus is that the extent of these examinations should be based on symptoms, severity and duration of COVID-19 and that individual return-to-training recommendations should be given.

Schlüsselwörter

Sportkardiologie - Leitlinien - körperliche Aktivität - kardiovaskuläre Krankheiten - COVID-19

Key words

sports cardiology - guidelines - exercise - cardiovascular disease - COVID-19

Publication History

Article published online:
22 September 2021

• Literatur

• 1 Pelliccia A, Sharma S, Gati S. et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42: 17-96
• 2 Mont L, Pelliccia A, Sharma S. et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. EP Europace 2016; 19: 139-163
• 3 Halle M, Niebauer J. ESC-Leitlinie Sportkardiologie 2020. Herz 2021; 46: 38-45
• 4 Martinez MW, Tucker AM, Bloom OJ. et al. Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening. JAMA Cardiol 2021; 6: 745-752
• 5 Gervasi SF, Pengue L, Damato L. et al. Is extensive cardiopulmonary screening useful in athletes with previous asymptomatic or mild SARS-CoV-2 infection?. Br J Sports Med 2021; 55: 54-61
• 6 Kim JH, Levine BD, Phelan D. et al. Coronavirus Disease 2019 and the Athletic Heart: Emerging Perspectives on Pathology, Risks, and Return to Play. JAMA Cardiol 2021; 6: 219-227
• 7 Löllgen H, Bachl N, Papadopoulou T. et al. Infographic. Clinical recommendations for return to play during the COVID-19 pandemic. Br J Sports Med 2021; 55: 344-345
• 8 Baggish A, Drezner JA, Kim J. et al. Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes. Br J Sports Med 2020; 54: 1130-1131
• 9 Wilson MG, Hull JH, Rogers J. et al. Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. Br J Sports Med 2020; 54: 1157-1161
• 10 Phelan D, Kim JH, Elliott MD. et al. Screening of Potenzial Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement. JACC Cardiovasc Imaging 2020; 13: 2635-2652
• 11 Elliott N, Martin R, Heron N. et al. Infographic. Graduated return to play guidance following COVID-19 infection. Br J Sports Med 2020; 54: 1174-1175