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Simple Summary Survivors of childhood brain tumors, because of the treatments they have undergone, have a greater risk of dying earlier from cardiovascular causes compared to the general population. The objective of this study was to evaluate differences between cardiovascular risk biomarkers and cardiopulmonary exercise test (CPET) results from childhood brain tumor survivors and healthy controls. We found worse CPET performance in survivors associated with higher endothelin-1 values compared to controls. Correlation analysis showed an inverse relationship between CPET results and leptin, emphasizing the role of radiotherapy as a possible cause in the genesis of a greater cardiovascular risk in survivors of childhood brain tumors.Abstract In recent decades, the improvement of treatments and the adoption of therapeutic protocols of international cooperation has led to an improvement in the survival of children affected by brain tumors. However, in parallel with the increase in survival, long-term side effects related to treatments have been observed over time, including the activation of chronic inflammatory processes and metabolic alterations, which can facilitate the onset of metabolic syndrome and increased cardiovascular risk. The aim of this study was to find possible statistically significant differences in the serum concentrations of early biomarkers of metabolic syndrome and in the results of cardiopulmonary exercise testing between survivors of childhood brain tumors and healthy controls. This is a prospective and observational study conducted on a group of 14 male patients who survived childhood brain tumors compared with the same number of healthy controls. The concentrations of early metabolic syndrome biomarkers [adiponectin, leptin, TNF-alpha, IL-1, IL-6, IL-10, endothelin-1, apolipoprotein B, and lipoprotein (a)] were measured and a cardiopulmonary exercise test (CPET) was performed. Results: Childhood brain tumor survivors performed worse on average

BACKGROUND: Return to play (RTP) protocols have been proposed to early detect cardiovascular involvement due to COVID-19 and reduce the risk of sports-related sudden cardiac death. However, uncertainties remain about the true prevalence of COVID-19 myopericarditis, the arrhythmic risk and the cost of this protocol. METHODS: We collected data from 217 competitive and professional athletes of both genders who underwent RTP protocol (clinical history, resting and exercise ECG, and echocardiography). Holter monitoring and/or cardiac magnetic resonance (CMR) were performed in case of abnormalities. In 107 athletes, the RTP data were compared with those of preparticipation evaluation (PPE) performed prior to COVID-19 infection. RESULTS: Out of 217 consecutive athletes evaluated with the RTP protocol, 7 underwent CMR: among these we found alterations compatible with myopericarditis in 3 (1.4%), with a cost per person of € 223.93 and a cost per diagnosis of € 16,197.53. Of the 107 athletes previously evaluated with PPE, 4 underwent RMC: we made a final diagnosis of myocarditis in 1 athlete (0.9%), whereas another athlete (0.9%) showed moderate pericardial effusion. The clinical presentation of both these athletes was characterized by the presence of ventricular arrhythmias newly detected during RTP. Compared to PPE, during RTP higher values were observed for shortness of breath, weight, heart rate and corrected QT interval, whereas lower values for sinus bradycardia and the E/A ratio of mitral flow. CONCLUSIONS: The prevalence of myopericarditis was similar to that reported in previous cross-sectional and case-control studies. The availability of data recorded before COVID-19 was important in the evaluation of athletes with arrhythmias. The RTP protocol has proven to be less cost effective than normal PPE.

Patients with repaired Tetralogy of Fallot (rToF) typically report having preserved subjective exercise tolerance. Chronic pulmonary regurgitation (PR) with varying degrees of right ventricular (RV) dilation as assessed by cardiac magnetic resonance imaging (MRI) is prevalent in rToF and may contribute to clinical compromise. Cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capacity, and the International Physical Activity Questionnaire (IPAQ) can provide additional data on physical activity (PA) achieved. Our aim was to assess the association between CPET values, IPAQ measures, and MRI parameters. All rToF patients who had both an MRI and CPET performed within one year between March 2019 and June 2021 were selected. Clinical data were extracted from electronic records (including demographic, surgical history, New York Heart Association (NYHA) functional class, QRS duration, arrhythmia, MRI parameters, and CPET data). PA level, based on the IPAQ, was assessed at the time of CPET. Eighty-four patients (22.8 +/- 8.4 years) showed a reduction in exercise capacity (median peak VO2 30 mL/kg/min (range 25-33); median percent predicted peak VO2 68% (range 61-78)). Peak VO2, correlated with biventricular stroke volumes (RVSV: beta = 6.11 (95%CI, 2.38 to 9.85), p = 0.002; LVSV: beta = 15.69 (95% CI 10.16 to 21.21), p < 0.0001) and LVEDVi (beta = 8.74 (95%CI, 0.66 to 16.83), p = 0.04) on multivariate analysis adjusted for age, gender, and PA level. Other parameters which correlated with stroke volumes included oxygen uptake efficiency slope (OUES) (RVSV: beta = 6.88 (95%CI, 1.93 to 11.84), p = 0.008; LVSV: beta = 17.86 (95% CI 10.31 to 25.42), p < 0.0001) and peak O-2 pulse (RVSV: beta = 0.03 (95%CI, 0.01 to 0.05), p = 0.007; LVSV: beta = 0.08 (95% CI 0.05 to 0.11), p < 0.0001). On multivariate analysis adjusted for age and gender, PA level correlated significantly with peak VO2/kg (beta = 0.02, 95% CI 0.003 to 0.04; p = 0.019).

Background: To assess the event rates of myocarditis detected by Cardiac Magnetic Resonance (CMR) in athletes who recovered from COVID-19. Methods: A systematic literature search was performed to identify studies reporting abnormal CMR findings in athletes who recovered from COVID-19. Secondary analyses were performed considering increased serum high sensitivity troponin (hs-Tn) levels and electrocardiographic (ECG) and echocardiographic (ECHO) abnormalities. Results: In total, 7988 athletes from 15 studies were included in the analysis. The pooled event rate of myocarditis was 1% (CI 1-2%), reaching 4% in the sub-group analysis. In addition, heterogeneity was observed (I2 43.8%). The pooled event rates of elevated serum hs-Tn levels, abnormal ECG and ECHO findings were 2% (CI 1-5%), 3% (CI 1-10%) and 2% (CI 1-6%), respectively. ECG, ECHO and serum hs-Tn level abnormalities did not show any correlation with myocarditis. Conclusions: The prevalence of COVID-19-related myocarditis in the athletic population ranges from 1 to 4%. Even if the event rate is quite low, current screening protocols are helpful tools for a safe return to play to properly address CMR studies. Trial registration: the study protocol was registered in the PROSPERO database (registration number: CRD42022300819).

Background: The aim of this study was to identify a possible link between bicuspid aortic valve (BAV) and premature ventricular beats (PVBs), particularly from left and right ventricular outflow tracts, and to investigate possible associations between these arrhythmias and echocardiographic abnormalities. Methods: A comparison of sportspeople with and without BAV was performed to identify PVBs' occurrence in these two series. Then, subdividing the BAV group on the presence of cardiovascular complications due to BAV, we compared arrhythmic features between these two subgroups and echocardiographic findings between athletes with and without left and right outflow tract PVBs. Results: PVBs in 343 athletes with BAV were compared with 309 athletes without BAV, showing an increased frequency (29% vs. 11.8%, p < 0.001; OR 3.1; CI 2.1-4.7) and origin from the left (18.4% vs. 3.2%, p < 0.001, OR 6.7; CI 3.4-13.4) and right (15.2% vs. 3.6%, p < 0.001, OR 4.8; CI 2.5-9.5) outflow tracts compared to other ventricular areas (fascicular PVBs p = 0.81, other morphologies p = 0.58). No difference in PVBs' occurrence was found between near normal valve BAV and pathological BAV, nor was a difference in echocardiographic characteristics found between patients with and without outflow tract arrhythmias. Conclusions: A possible causal link between BAV and PVBs was highlighted, but no association between PVBs and complicated BAV was emphasized.

BACKGROUND: Boxing is an ancient sport practiced as amateur or professional activity. Recent changes in amateur boxing rules seemed to make these two sports more similar regarding the injury profile. Aim of this study was to com-pare the injury rate in amateur and professional boxing after the rules' change.METHODS: From September 2016 to June 2022, two of the authors recorded all medical conditions occurred during male boxing activity while overseeing the medical assistance of boxing events. The total number of boxing matches (and boxers) during the events was recorded. In case of a medical condition, age and body weight of the athlete were collected as well as if he was competing in amateur or professional boxing. Data related to the type of injury, treat-ment, hospital referral, other investigations, final diagnosis and boxing decision were recorded.RESULTS: In 60 months, 75 medical conditions were recorded in 36 boxing events and 349 matches (698 boxers, 54% amateur). The mean body weight of injured boxers was 68.7 +/- 9.5 kg, with no difference in respect to non-injured boxers (68.6 +/- 9.2 kg). No difference in injury rate was met when comparing different weight divisions. No major trauma was observed. Among different injury rate parameters, only the injury rate per 100 athletes proved to be higher in professional (20.19) than amateur (9.06) boxers (odd ratio 2.54). Facial wounds were the most prevalent injury, with no difference between amateur (11) and professional (4) boxers.CONCLUSIONS: Comparing amateur and professional boxing, our study showed a higher injury rate per 100 athletes in professional boxers, even if all other injury rate exposure parameters resulted not different. When an injury oc-curred, the kind of verdict and the type of injury were not different between amateur and professional boxing.

BACKGROUND: Although peak oxygen uptake (VO2peak) is considered the most useful index of functional capacity; it's difficult to interpret the results of cardiopulmonary exercise testing (CPET) in individuals with spinal cord injury (SCI). In fact, VO2peak is usually normalized for total body weight, but body composition in persons with SCI largely varies depending on physical activity and time since injury, with a progressive loss of fat-free mass (FFM). This can lead to a misinterpretation of the cardiopulmonary fitness in this population.AIM: Our study proposes a methodology of evaluation, based on bioelectrical impedance analysis (BIA), which could provide more individualized and accurate data in sportsmen with SCI.DESIGN: Case-control study.POPULATION: Ambulatory patients at the Sports Medicine Unit of the IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.METHODS: Comparison of data derived from BIA, echocardiography and CPET between 10 male sportsmen with complete, high SCI (group T) and 10 able-bodied controls (group C).RESULTS: Mean VO2peak, weight-normalized VO2peak, fat-free mass (FFM)-normalized VO2peak and body cellular mass (BCM)-normalized values were significantly lower in group T. At the same heart rate (on average the 55% of the maximal theoretical for age), mean of absolute VO2, weight-normalized VO2 and FFM-normalized VO2 were still significantly lower in group T. Considering the BCM-normalized VO2, the group T showed greater values than controls, 39.4 +/- 7.8 vs. 31.1 +/- 8.5 mL/kg/min.CONCLUSIONS: Body composition is a crucial factor for properly interpreting a CPET in individuals with SCI. In particular, normalization of VO2peak values for the BCM seems the most reliable tool to assess the real functional capacity in this population.CLINICAL REHABILITATION IMPACT: A more accurate definition of the aerobic power and functional capacity of people with SCI can improve the monitoring of rehabilitations protocols and physical exercise in

Background and objectives: An Italian nationwide pre-participation screening approach for prevention of sudden cardiac death in athletes (SCD-A) in competitive sportspeople showed promising results but did not achieve international consensus, due to cost-effectiveness and the shortfall of a monitoring plan. From this perspective, we tried to provide an epidemiological update of SCD-A in Italy through a year-long internet-based search. Materials and Methods: One year-long Google search was performed using mandatory and non-mandatory keywords. Data were collected according to prevalent SCD-A definition and matched with sport-related figures from Italian National Institute of Statistics (ISTAT) and Italian National Olympic Committee (CONI). Results: Ninety-eight cases of SCD-A in 2019 were identified (48.0% competitive, 52.0% non-competitive athletes). Male/female ratio was 13:1. The most common sports were soccer (33.7%), athletics (15.3%) and fitness (13.3%). A conclusive diagnosis was achieved only in 37 cases (33 of cardiac origin), with the leading diagnosis being coronary artery disease in 27 and a notably higher occurrence among master athletes. Combining these findings with ISTAT and CONI data, the SCD-A incidence rate in the whole Italian sport population was found to be 0.47/100,000 persons per year (1.00/100,000 in the competitive and 0.32/100,000 in the non-competitive population). The relative risk of SCD-A is 3.1 (CI 2.1-4.7; p < 0.0001) for competitive compared to non-competitive athletes; 9.9 for male (CI 4.6-21.4; p < 0.0001) with respect to female. Conclusions: We provided an updated incidence rate of SCD-A in both competitive and non-competitive sport in Italy. A higher risk of SCD-A among competitive and male athletes was confirmed, thus corroborating the value of Italian pre-participation screening in this population.