Exploring the frontiers in sports cardiology From core concepts to extreme phenotypes

This thesis focuses on safe guidance for athletes by establishing infrastructure and improving current understandings in sports cardiology. We have enhanced clinical care pathways for athletes, patients, and healthcare professionals within sports cardiology. Initially, by identifying substantial interest in sports cardiology in The Netherlands, which underscores the need for future educational tracks, collaborations, and accreditations to meet the demand for expertise. Additionally, by concluding that a multidisciplinary team approach in sports cardiology is of added value, leading to better tailored care and less restrictive and personalised sports advices for athletes and patients wishing to participate or already participating in sports. Furthermore, by introducing the rationale and design of our ongoing ELITE prospective, multicentre, longitudinal cohort study, aiming to investigate sports-specific, extreme cardiac phenotypes and genotypes in the elite athlete population.
Moreover, we have expanded the understanding of the potential limits of exercise-induced cardiac remodelling, also under extreme circumstances such as after SARS-CoV-2 infection. Firstly, by highlighting distinct female-specific features of exercise-induced cardiac remodelling, which can assist clinicians in distinguishing physiological cardiac adaptation from potential cardiac pathology in female athletes. Secondly, by concluding that infection with SARS-CoV-2 is associated with a low overall risk of pericardial or myocardial involvement, arrhythmias, and sudden cardiac arrest or death in athletes. Finally, by presenting longer-term, reassuring insights concerning cardiac safety in the context of elite-level sports following SARS-CoV-2 infection. In conclusion, to optimise health benefits while minimising cardiovascular risks for individuals engaged in sports, both a strong foundation and an understanding of extreme phenotypes in challenging contexts are mandatory.