Pushing boundaries, not the heart: a comparative look at pericarditis recurrence in athletes

Abstract Background While regular exercise is generally celebrated for its cardiovascular benefits, there’s an ongoing debate about whether intense training might increase the risk of repeated inflammation in patients with pericarditis. Since up to 30% of individuals with pericarditis experience at least one recurrence, it’s been suggested that athletes—who push their cardiac workload and heart rate to higher levels—could be more prone to relapse. Yet, data on this possible link remain limited. Purpose This study aims to determine whether athletes have an increased risk of recurrent pericarditis, compared to a propensity score-matched cohort of non-athletes. Methods Consecutive patients with acute or recurrent pericarditis, evaluated at a specialised pericarditis centre, were included in a prospective registry. Diagnosis of pericarditis was done according to 2015 ESC Guidelines, requiring two of the following: pericarditic chest pain, friction rubs, pericardial effusion, or electrocardiographic changes. Those engaging in ≥4 hours of structured training per week (recreational or competitive) were defined as athletes, while those performing minimal or no structured physical activity were considered as non-athletes. Using a 1:1 propensity score matching, athletes were paired with non-athletes according to baseline heart rate, age, gender, and use of colchicine, corticosteroids, or beta-blockers. Patients were assessed for pericarditis recurrence over a 6-month follow-up. Results Our final sample included 108 patients: 54 athletes matched to 54 non-athletes, with similar baseline characteristics (Table 1). After six months, 14% of the athletes had recurrent pericarditis versus 28% of non-athletes (log-rank p=0.130, Figure 1). Conclusions Our findings indicate that athletes do not have a significantly increased risk of pericarditis recurrence compared to non-athletes. These results contribute to a better understanding of return-to-play recommendations and support the potential for individualized management strategies in athletes recovering from pericarditis. Further research with larger cohorts is necessary to confirm these findings.Table 1 Figure 1