Oliveira Leonardo P J, Lawless Christine E
Cleveland Clinic Sports Health, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Curr Sports Med Rep. 2011 Mar-Apr;10(2):65-77. doi: 10.1249/JSR.0b013e3182159a55.
Clinicians who treat millions of adult athletes throughout the world may be faced with participation or return-to-play decisions in individuals with known or suspected cardiac conditions. Here we review existing published participation guidelines and analyze emerging data from ongoing registries and population-based studies pertaining to return-to-play decisions for cardiac conditions specifically affecting adult athletes. Considerations related to return-to-play decisions will vary according to age of the athlete, with inherited disorders being the main consideration in younger adult athletes aged 18 to 40 yr, and coronary artery disease being the main consideration in older adult athletes aged 40 yr and older. Although this arbitrary division is based on the epidemiology of underlying heart disease in these populations, the essential return-to-play decision process for both age groups is quite similar. Among the most widely used guidelines to make return-to-play decisions in this group of athletes are the 36th Bethesda Conference Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities. These have long been considered the "gold standard" for determining return-to-play decisions in young athletes in the United States. Other guidelines are available for unique purposes, including The European Society of Cardiology guidelines, and the American Heart Association published recommendations regarding participation of young patients (younger than 40 yr) with genetic cardiovascular diseases in recreational sports. The latter are consistent with the 36th Bethesda guidelines and cover common genetically based diseases such as inherited cardiomyopathies, channelopathy, and connective tissue disorders like Marfan's syndrome. The consensus on masters athletes (older than 40 yr) provides return-to-play decisions for a wide variety of conditioned states, from elite older athletes to walk-up athletes. For any adult athlete with a cardiac condition, return-to-play decisions following use of medications, ablation procedures, device implantation, corrective surgery, or coronary intervention depend on whether the procedure has sufficiently altered the risk for sudden cardiac events, and whether there is a potential for unfavorable interaction with cardiac performance.
全球数百万成年运动员的治疗医生可能会面临为已知或疑似患有心脏疾病的个体做出参赛或重返赛场决定的情况。在此，我们回顾现有的已发表参赛指南，并分析来自正在进行的登记研究和基于人群的研究的新数据，这些数据与针对特定影响成年运动员的心脏疾病的重返赛场决定相关。与重返赛场决定相关的考量因素会因运动员年龄而异，遗传性疾病是18至40岁年轻成年运动员的主要考量因素，而冠状动脉疾病是40岁及以上老年成年运动员的主要考量因素。尽管这种人为划分是基于这些人群中心脏疾病的流行病学情况，但这两个年龄组的基本重返赛场决定过程非常相似。在为这组运动员做出重返赛场决定时，最广泛使用的指南之一是第36届贝塞斯达会议关于心血管异常竞技运动员参赛资格的建议。长期以来，这些建议一直被视为美国年轻运动员重返赛场决定的“金标准”。其他指南则用于特定目的，包括欧洲心脏病学会指南以及美国心脏协会发表的关于患有遗传性心血管疾病的年轻患者（40岁以下）参与休闲运动的建议。后者与第36届贝塞斯达指南一致，涵盖常见的基于基因的疾病，如遗传性心肌病、离子通道病以及像马凡综合征这样的结缔组织疾病。关于老年运动员（40岁以上）的共识为从精英老年运动员到普通运动员等各种身体状况的运动员提供了重返赛场决定。对于任何患有心脏疾病的成年运动员，在使用药物、消融手术、器械植入、矫正手术或冠状动脉介入治疗后做出重返赛场决定，取决于该治疗是否充分改变了心脏性猝死的风险，以及是否存在与心脏功能产生不利相互作用的可能性。
