Table 9 Recommendations for CMR in the guidelines on sports cardiology and exercise in patients with cardiovascular disease

Recommendations for exercise and participation in sports in individuals with aortic pathology

Prior to engaging in exercise, risk stratification, with careful assessment including advanced imaging of the aorta (CT/CMR) and exercise testing

with blood pressure assessment is recommended

I

C

Recommendations for exercise in individuals with left ventricular non-compaction cardiomyopathy (LVNC)

A diagnosis of LVNC in athletic individuals should be considered if they fulfill imaging criteria, in association with cardiac symptoms, family history of LVNC or cardiomyopathy, left ventricular systolic (EF < 50%) or diastolic (E’ < 9 cm/s) dysfunction, a thin compacted epicardial layer (< 5 mm in end-diastole on CMR, or < 8 mm in systole on echocardiography), or abnormal 12-lead ECG

IIa

B

Recommendations for exercise in individuals with dilated cardiomyopathy (DCM)

Participation in high- or very high-intensity exercise including competitive sports (with the exception of those where occurrence of syncope may be associated with harm or death) may be considered in asymptomatic individuals who fulfill all of the following: (i) mildly reduced left ventricular systolic function (EF 45–50%); (ii) absence of frequent and/or complex ventricular arrhythmias on ambulatory Holter monitoring or exercise testing; (iii) absence of LGE on CMR; (iv) ability to increase EF by 10–15% during exercise; and (v) no evidence of high-risk genotype (lamin A/C or filamin C)

IIb

C

Participation in high- or very high-intensity exercise including competitive sports is not recommended for individuals with a DCM and any of the following: (i) symptoms or history of cardiac arrest or unexplained syncope; (ii) LVEF < 45%; (iii) frequent and/or complex ventricular arrhythmias on ambulatory Holter monitoring or exercise testing; (iv) extensive LGE (> 20%) on CMR; or (v) high-risk genotype (lamin A/C or filamin C)

III

C

Recommendations for exercise in individuals with myocarditis

Return to all forms of exercise including competitive sports should be considered after 3–6 months in asymptomatic individuals, with normal troponin and biomarkers of inflammation, normal LV systolic function on echocardiography and CMR, no evidence of ongoing inflammation or myocardial fibrosis on CMR, good functional capacity, and absence of frequent and/or complex ventricular arrhythmias on ambulatory Holter monitoring or exercise testing

IIa

C