{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:58:28Z","timestamp":1792119508864,"version":"4.4.0"},"reference-count":177,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Sports-associated traumatic brain injury is emerging as an under-recognized driver of acute and chronic cardiovascular diseases. Larger population-based studies show that individuals with moderate-to-severe traumatic brain injury experience up to a two-fold excess risk of incident hypertension, coronary artery disease, myocardial infarction, and stroke that persists for at least a decade. Among former professional American-style football players, a higher lifetime concussion burden is uniquely related to a more atherogenic cardiometabolic profile and greater long-term stroke risk. Mechanistically, an acute \u201csympathetic storm\u201d triggered by cerebral injury provokes catecholamine surges, endothelial dysfunction, and myocardial stunning, manifesting as neurogenic stunned myocardium or Takotsubo-like cardiomyopathy and malignant arrhythmias. Sub-acute to chronic phases are characterized by persistent autonomic imbalance, reflected by reduced heart-rate variability and impaired baroreflex sensitivity weeks to months after concussion, coupled with neuroinflammation, hypothalamic\u2013pituitary\u2013adrenal axis dysregulation, and lifestyle changes that accelerate atherosclerosis. The interplay of these pathways accounts for the elevated burden of cardiovascular disease observed long after neurological function has been restored. Despite robust evidence linking TBI to adverse cardiac outcomes, contemporary sports\u2013cardiology risk stratification prioritizes hemodynamic load, genetics, and performance-enhancing substances, largely overlooking brain injury history. This review integrates epidemiological, clinical, and mechanistic data to (i) delineate acute neurocardiac complications secondary of sports-related traumatic brain injury, (ii) synthesize evidence for chronic cardiovascular risk, (iii) highlight emerging autonomic and inflammatory biomarkers, and (iv) propose surveillance and therapeutic strategies, ranging from heart-rate-variability-guided return-to-play decisions to aggressive cardiometabolic risk modification aiming to mitigate long-term morbidity in this athletic population. By framing sports-related traumatic brain injury as a modifiable cardiovascular risk factor, we aim to foster interdisciplinary collaboration among neurologists, cardiologists, and sports medicine practitioners, ultimately improving both neurological and cardiovascular outcomes across the athlete\u2019s lifespan.<\/jats:p>","DOI":"10.3390\/jcm14217712","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:28:43Z","timestamp":1761888523000},"page":"7712","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Bidirectional Interplay Between Traumatic Brain Injury and Cardiovascular Dysfunction in Athletes"],"prefix":"10.3390","volume":"14","author":[{"given":"Fazle","family":"Kibria","sequence":"first","affiliation":[{"name":"Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga A.","family":"Bragina","sequence":"additional","affiliation":[{"name":"Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5928-0068","authenticated-orcid":false,"given":"Alex O.","family":"Trofimov","sequence":"additional","affiliation":[{"name":"Department of Neurological Diseases, Privolzhsky Research Medical University, 603005 Nizhny Novgorod, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4894-0061","authenticated-orcid":false,"given":"Denis","family":"Bragin","sequence":"additional","affiliation":[{"name":"Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA"},{"name":"Department of Neurology, The University of New Mexico School of Medicine, Albuquerque, NM 87106, USA"},{"name":"Department of Physiology, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s13643-023-02264-8","article-title":"The impact of sports participation on mental health and social outcomes in adults: A systematic review and the \u2018Mental Health through Sport\u2019 conceptual model","volume":"12","author":"Eather","year":"2023","journal-title":"Syst. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1111\/sms.13703","article-title":"Relationship of participation in specific sports to academic performance in adolescents: A 2-year longitudinal study","volume":"30","author":"Ishihara","year":"2020","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Malm, C., Jakobsson, J., and Isaksson, A. (2019). Physical Activity and Sports-Real Health Benefits: A Review with Insight into the Public Health of Sweden. Sports, 7.","DOI":"10.3390\/sports7050127"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Latino, F., and Tafuri, F. (2024). Physical Activity and Cognitive Functioning. Medicina, 60.","DOI":"10.3390\/medicina60020216"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6950","DOI":"10.1007\/s12035-023-03492-8","article-title":"Exercise Reshapes the Brain: Molecular, Cellular, and Structural Changes Associated with Cognitive Improvements","volume":"60","author":"Arrifano","year":"2023","journal-title":"Mol. Neurobiol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mart\u00edn-Rodr\u00edguez, A., Gostian-Ropotin, L.A., Beltr\u00e1n-Velasco, A.I., Belando-Pedre\u00f1o, N., Sim\u00f3n, J.A., L\u00f3pez-Mora, C., Navarro-Jim\u00e9nez, E., Tornero-Aguilera, J.F., and Clemente-Su\u00e1rez, V.J. (2024). Sporting Mind: The Interplay of Physical Activity and Psychological Health. Sports, 12.","DOI":"10.3390\/sports12010037"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1093\/eurheartj\/ehad170","article-title":"Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation","volume":"44","author":"Valenzuela","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E519","DOI":"10.1152\/ajpendo.00617.2013","article-title":"Exercise training boosts eNOS-dependent mitochondrial biogenesis in mouse heart: Role in adaptation of glucose metabolism","volume":"306","author":"Vettor","year":"2014","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e168121","DOI":"10.1172\/JCI168121","article-title":"Exercise, exerkines, and cardiometabolic health: From individual players to a team sport","volume":"133","author":"Robbins","year":"2023","journal-title":"J. Clin. Investig."},{"key":"ref_10","unstructured":"Johns Hopkins Medicine (2024, July 15). Sports Injury Statistics. Available online: https:\/\/www.hopkinsmedicine.org\/health\/conditions-and-diseases\/sports-injuries\/sports-injury-statistics."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Han, J., Lalario, A., Merro, E., Sinagra, G., Sharma, S., Papadakis, M., and Finocchiaro, G. (2023). Sudden Cardiac Death in Athletes: Facts and Fallacies. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10020068"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1161\/CIRCULATIONAHA.123.065908","article-title":"Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study","volume":"149","author":"Petek","year":"2024","journal-title":"Circulation"},{"key":"ref_13","first-page":"627","article-title":"Sports-related sudden cardiac arrest in young adults","volume":"25","author":"Bohm","year":"2022","journal-title":"EP Eur."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.jacc.2023.01.015","article-title":"Incidence of Cardiac Arrest During Sports Among Women in the European Union","volume":"81","author":"Weizman","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1161\/CIRCULATIONAHA.111.023838","article-title":"Epidemiology and Genetics of Sudden Cardiac Death","volume":"125","author":"Deo","year":"2012","journal-title":"Circulation"},{"key":"ref_16","unstructured":"The University of Kansas Health System (2025, March 20). The Scary Side of Sports. Available online: https:\/\/www.kansashealthsystem.com\/news-room\/blog\/0001\/01\/cardiac-death-young-athletes."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e200123","DOI":"10.1212\/CPJ.0000000000200123","article-title":"Sport-Related Concussion: A Cognitive Perspective","volume":"13","author":"Hallock","year":"2023","journal-title":"Neurol. Clin. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Esterov, D., and Greenwald, B.D. (2017). Autonomic Dysfunction after Mild Traumatic Brain Injury. Brain Sci., 7.","DOI":"10.3390\/brainsci7080100"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Keane, R.W., Hadad, R., Scott, X.O., Cabrera Ranaldi, E.D.L.R.M., P\u00e9rez-B\u00e1rcena, J., and de Rivero Vaccari, J.P. (2023). Neural-Cardiac Inflammasome Axis after Traumatic Brain Injury. Pharmaceuticals, 16.","DOI":"10.3390\/ph16101382"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1002\/jnr.24100","article-title":"Characterizing the relationship between systemic inflammatory response syndrome and early cardiac dysfunction in traumatic brain injury","volume":"96","author":"Chaikittisilpa","year":"2018","journal-title":"J. Neurosci. Res."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wee, I.C., Arulsamy, A., Corrigan, F., and Collins-Praino, L. (2024). Long-Term Impact of Diffuse Traumatic Brain Injury on Neuroinflammation and Catecholaminergic Signaling: Potential Relevance for Parkinson\u2019s Disease Risk. Molecules, 29.","DOI":"10.3390\/molecules29071470"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1001\/jamaneurol.2022.2682","article-title":"Association Between Traumatic Brain Injury and Subsequent Cardiovascular Disease Among Post-9\/11\u2013Era Veterans","volume":"79","author":"Stewart","year":"2022","journal-title":"JAMA Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/S1474-4422(23)00241-7","article-title":"Long-term risk of cardiovascular disease after traumatic brain injury: Screening and prevention","volume":"22","author":"Izzy","year":"2023","journal-title":"Lancet Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sobolewska-Nowak, J., Wachowska, K., Nowak, A., Orzechowska, A., Szulc, A., P\u0142aza, O., and Ga\u0142ecki, P. (2023). Exploring the Heart\u2013Mind Connection: Unraveling the Shared Pathways between Depression and Cardiovascular Diseases. Biomedicines, 11.","DOI":"10.3390\/biomedicines11071903"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s00399-021-00776-1","article-title":"The cardiac autonomic nervous system: An introduction","volume":"32","author":"Shen","year":"2021","journal-title":"Herzschrittmacherther. Elektrophysiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.tcm.2020.04.011","article-title":"The role of the autonomic nervous system in cardiac arrhythmias: The neuro-cardiac axis, more foe than friend?","volume":"31","author":"Manolis","year":"2021","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102923","DOI":"10.1016\/j.autneu.2021.102923","article-title":"Autonomic dysfunction and cardiovascular risk in post-traumatic stress disorder","volume":"237","author":"Fu","year":"2022","journal-title":"Auton. Neurosci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1007\/s10072-021-05128-y","article-title":"Cardiovascular autonomic dysfunction after stroke","volume":"42","author":"Racosta","year":"2021","journal-title":"Neurol. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.conb.2019.11.009","article-title":"The microbiome-gut-brain axis in acute and chronic brain diseases","volume":"61","author":"Benakis","year":"2020","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/s12974-021-02264-2","article-title":"Systemic inflammation alters the neuroinflammatory response: A prospective clinical trial in traumatic brain injury","volume":"18","author":"Lindblad","year":"2021","journal-title":"J. Neuroinflamm."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1089\/neu.2019.6885","article-title":"Beyond the Brain: Peripheral Interactions after Traumatic Brain Injury","volume":"37","author":"McDonald","year":"2020","journal-title":"J. Neurotrauma"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"577619","DOI":"10.1016\/j.jneuroim.2021.577619","article-title":"Multipotential and systemic effects of traumatic brain injury","volume":"357","author":"Sabet","year":"2021","journal-title":"J. Neuroimmunol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Rachfalska, N., Putowski, Z., and Krzych, \u0141.J. (2020). Distant Organ Damage in Acute Brain Injury. Brain Sci., 10.","DOI":"10.3390\/brainsci10121019"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1161\/CIRCRESAHA.116.308687","article-title":"Acute Catecholamine Exposure Causes Reversible Myocyte Injury Without Cardiac Regeneration","volume":"119","author":"Wallner","year":"2016","journal-title":"Circ. Res."},{"key":"ref_35","first-page":"e6957","article-title":"A Review of Catecholamine Associated Cardiomyopathies and Channelopathies","volume":"12","author":"Sethi","year":"2020","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.ccm.2008.01.007","article-title":"Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist\u2014Better Approaches to Patient Ventilator Synchrony?","volume":"29","author":"Sinderby","year":"2008","journal-title":"Clin. Chest Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"103160","DOI":"10.1016\/j.autneu.2024.103160","article-title":"Assessment of cardiovascular functioning following sport-related concussion: A physiological perspective","volume":"252","author":"Ellingson","year":"2024","journal-title":"Auton. Neurosci."},{"key":"ref_38","first-page":"519","article-title":"Crosstalk between brain, lung and heart in critical care","volume":"39","author":"Mrozek","year":"2020","journal-title":"Anaesth. Crit. Care Pain. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5842182","DOI":"10.1155\/2017\/5842182","article-title":"A Review of Neurogenic Stunned Myocardium","volume":"2017","author":"Biso","year":"2017","journal-title":"Cardiovasc. Psychiatry Neurol."},{"key":"ref_40","first-page":"137","article-title":"Extracranial complications after traumatic brain injury: Targeting the brain and the body","volume":"26","author":"Robba","year":"2020","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1385\/NCC:5:3:243","article-title":"Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage","volume":"5","author":"Lee","year":"2006","journal-title":"Neurocrit Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"228","DOI":"10.4103\/aca.ACA_176_17","article-title":"Neurogenic stress cardiomyopathy: What do we need to know","volume":"21","author":"Gopinath","year":"2018","journal-title":"Ann. Card. Anaesth."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1161\/CIRCRESAHA.117.311170","article-title":"Brain-Heart Interaction: Cardiac Complications After Stroke","volume":"121","author":"Chen","year":"2017","journal-title":"Circ. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S1566-0702(00)00220-4","article-title":"Neural and humoral pathways of communication from the immune system to the brain: Parallel or convergent?","volume":"85","author":"Dantzer","year":"2000","journal-title":"Auton. Neurosci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jcrc.2016.10.010","article-title":"Neurogenic stunned myocardium in subarachnoid hemorrhage","volume":"38","author":"Kerro","year":"2017","journal-title":"J. Crit. Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1007\/s00134-023-07165-x","article-title":"Clinical targeting of the cerebral oxygen cascade to improve brain oxygenation in patients with hypoxic\u2013ischaemic brain injury after cardiac arrest","volume":"49","author":"Hoiland","year":"2023","journal-title":"Intensive Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e158","DOI":"10.1161\/CIR.0000000000001219","article-title":"Improving Outcomes After Post\u2013Cardiac Arrest Brain Injury: A Scientific Statement from the International Liaison Committee on Resuscitation","volume":"150","author":"Perkins","year":"2024","journal-title":"Circulation"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/s12975-022-01047-y","article-title":"Neuroprotection of NSC Therapy is Superior to Glibenclamide in Cardiac Arrest-Induced Brain Injury via Neuroinflammation Regulation","volume":"14","author":"Wang","year":"2023","journal-title":"Transl. Stroke Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e689","DOI":"10.1097\/SLA.0000000000005041","article-title":"Inflammation Disrupts the Brain Network of Executive Function after Cardiac Surgery","volume":"277","author":"Zhu","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e01","DOI":"10.15420\/aer.2022.29","article-title":"This is Your Brain, and This is Your Brain on Atrial Fibrillation: The Roles of Cardiac Malperfusion Events and Vascular Dysfunction in Cognitive Impairment","volume":"12","author":"Zenger","year":"2023","journal-title":"Arrhythm. Electrophysiol. Rev."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Boere, K., Lloyd, K., Binsted, G., and Krigolson, O.E. (2023). Exercising is good for the brain but exercising outside is potentially better. Sci. Rep., 13.","DOI":"10.1038\/s41598-022-26093-2"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1161\/CIR.0000000000001148","article-title":"Increasing Equity of Physical Activity Promotion for Optimal Cardiovascular Health in Adults: A Scientific Statement from the American Heart Association","volume":"147","author":"Jerome","year":"2023","journal-title":"Circulation"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Przew\u0142\u00f3cka, K., Korewo-Labelle, D., Berezka, P., Karnia, M.J., and Kaczor, J.J. (2024). Current Aspects of Selected Factors to Modulate Brain Health and Sports Performance in Athletes. Nutrients, 16.","DOI":"10.3390\/nu16121842"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e19636","DOI":"10.1016\/j.heliyon.2023.e19636","article-title":"Narrative review: The role of circadian rhythm on sports performance, hormonal regulation, immune system function, and injury prevention in athletes","volume":"9","author":"Nobari","year":"2023","journal-title":"Heliyon"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/ageing\/afh201","article-title":"Interventions for sarcopenia and muscle weakness in older people","volume":"33","author":"Borst","year":"2004","journal-title":"Age Ageing"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e2228510","DOI":"10.1001\/jamanetworkopen.2022.28510","article-title":"Association of Leisure Time Physical Activity Types and Risks of All-Cause, Cardiovascular, and Cancer Mortality Among Older Adults","volume":"5","author":"Watts","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e219","DOI":"10.1016\/S2468-2667(21)00302-9","article-title":"Daily steps and all-cause mortality: A meta-analysis of 15 international cohorts","volume":"7","author":"Paluch","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Bucciarelli, V., Mattioli, A.V., Sciomer, S., Moscucci, F., Renda, G., and Gallina, S. (2023). The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women\u2019s Lifespan: An Updated Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134347"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC)","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_60","unstructured":"World Health Organization (2025, February 10). Physical Activity. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/physical-activity."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"112105","DOI":"10.1016\/j.exger.2023.112105","article-title":"Aging, aerobic exercise, and cardiovascular health: Barriers, alternative strategies and future directions","volume":"173","author":"Murray","year":"2023","journal-title":"Exp. Gerontol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1038\/s41392-022-01153-1","article-title":"Exercise training maintains cardiovascular health: Signaling pathways involved and potential therapeutics","volume":"7","author":"Chen","year":"2022","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s12265-022-10310-4","article-title":"Irisin Regulates Cardiac Responses to Exercise in Health and Diseases: A Narrative Review","volume":"16","author":"Zhu","year":"2023","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e217","DOI":"10.1161\/CIR.0000000000001189","article-title":"Resistance Exercise Training in Individuals with and Without Cardiovascular Disease: 2023 Update: A Scientific Statement from the American Heart Association","volume":"149","author":"Paluch","year":"2024","journal-title":"Circulation"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1038\/s41416-023-02410-y","article-title":"Effect of a 1-year physical activity intervention on cardiovascular health in long-term childhood cancer survivors\u2014A randomised controlled trial (SURfit)","volume":"129","author":"Rueegg","year":"2023","journal-title":"Br. J. Cancer"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2638","DOI":"10.1093\/cvr\/cvad161","article-title":"Exercise-induced circular RNA circUtrn is required for cardiac physiological hypertrophy and prevents myocardial ischaemia\u2013reperfusion injury","volume":"119","author":"Wang","year":"2023","journal-title":"Cardiovasc. Res."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Meng, J., Geng, Q., Jin, S., Teng, X., Xiao, L., Wu, Y., and Tian, D. (2023). Exercise protects vascular function by countering senescent cells in older adults. Front. Physiol., 14.","DOI":"10.3389\/fphys.2023.1138162"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1113\/JP282896","article-title":"The time is now: Regular exercise maintains vascular health in ageing women","volume":"601","author":"Wickham","year":"2023","journal-title":"J. Physiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1249\/MSS.0000000000001310","article-title":"Cardiometabolic Correlates of Physical Activity and Sedentary Patterns in U.S. Youth","volume":"49","author":"Jenkins","year":"2017","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1136\/bjsports-2017-098558","article-title":"Effects of frequency, intensity, duration and volume of walking interventions on CVD risk factors: A systematic review and meta-regression analysis of randomised controlled trials among inactive healthy adults","volume":"52","author":"Oja","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1161\/01.RES.86.2.119","article-title":"Mitochondrial oxidative stress in heart failure: \u201coxygen wastage\u201d revisited","volume":"86","author":"Sawyer","year":"2000","journal-title":"Circ. Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.freeradbiomed.2007.02.006","article-title":"Exercise-induced cardioprotection against myocardial ischemia-reperfusion injury","volume":"44","author":"Powers","year":"2008","journal-title":"Free Radic. Biol. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1084\/jem.189.11.1699","article-title":"Exercise provides direct biphasic cardioprotection via manganese superoxide dismutase activation","volume":"189","author":"Yamashita","year":"1999","journal-title":"J. Exp. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1161\/CIRCULATIONAHA.120.050446","article-title":"Long Noncoding RNA Cardiac Physiological Hypertrophy-Associated Regulator Induces Cardiac Physiological Hypertrophy and Promotes Functional Recovery After Myocardial Ischemia-Reperfusion Injury","volume":"144","author":"Gao","year":"2021","journal-title":"Circulation"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1038\/s41536-021-00128-0","article-title":"Targets identified from exercised heart: Killing multiple birds with one stone","volume":"6","author":"Wang","year":"2021","journal-title":"npj Regen. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1152\/physrev.00042.2007","article-title":"eNOS activation by physical forces: From short-term regulation of contraction to chronic remodeling of cardiovascular tissues","volume":"89","author":"Balligand","year":"2009","journal-title":"Physiol. Rev."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.yjmcc.2016.11.008","article-title":"Key role of endothelium in the eNOS-dependent cardioprotection with exercise training","volume":"102","author":"Farah","year":"2017","journal-title":"J. Mol. Cell Cardiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1038\/s41580-018-0052-8","article-title":"The machineries, regulation and cellular functions of mitochondrial calcium","volume":"19","author":"Giorgi","year":"2018","journal-title":"Nat. Rev. Mol. Cell Biol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2734","DOI":"10.1016\/S0006-3495(03)75079-6","article-title":"An integrated model of cardiac mitochondrial energy metabolism and calcium dynamics","volume":"84","author":"Cortassa","year":"2003","journal-title":"Biophys. J."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"H1055","DOI":"10.1152\/ajpheart.00925.2003","article-title":"Regular exercise is associated with a protective metabolic phenotype in the rat heart","volume":"287","author":"Burelle","year":"2004","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1007\/s12265-021-10100-4","article-title":"Exercise and Circulating Microparticles in Healthy Subjects","volume":"14","author":"Han","year":"2021","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s00395-017-0628-z","article-title":"Exercise-induced circulating extracellular vesicles protect against cardiac ischemia-reperfusion injury","volume":"112","author":"Bei","year":"2017","journal-title":"Basic. Res. Cardiol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1038\/s41467-018-04083-1","article-title":"Exercise induces new cardiomyocyte generation in the adult mammalian heart","volume":"9","author":"Vujic","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1002\/clc.24095","article-title":"Sudden cardiac arrest in athletes and strategies to optimize preparedness","volume":"46","author":"Malik","year":"2023","journal-title":"Clin. Cardiol."},{"key":"ref_85","first-page":"874","article-title":"Identifying Sudden Cardiac Arrest Risk in Adolescent Male Athletes","volume":"17","author":"Sattler","year":"2024","journal-title":"Int. J. Exerc. Sci."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.jacc.2023.10.032","article-title":"Sudden Cardiac Death in Young Athletes","volume":"83","author":"Finocchiaro","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1093\/eurheartj\/ehad017","article-title":"Value of screening for the risk of sudden cardiac death in young competitive athletes","volume":"44","author":"Sarto","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/bjsports-2023-107367","article-title":"Socioeconomic deprivation and racialised disparities in competitive athletes with sudden cardiac arrest from the USA","volume":"58","author":"Arthur","year":"2024","journal-title":"Br. J. Sports Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1161\/CIRCULATIONAHA.108.804617","article-title":"Sudden deaths in young competitive athletes: Analysis of 1866 deaths in the United States, 1980\u20132006","volume":"119","author":"Maron","year":"2009","journal-title":"Circulation"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"94","DOI":"10.31083\/j.rcm2403094","article-title":"Exercise and the Heart: Benefits, Risks and Adverse Effects of Exercise Training","volume":"24","author":"Mannakkara","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1016\/j.jacc.2003.03.002","article-title":"Does sports activity enhance the risk of sudden death in adolescents and young adults?","volume":"42","author":"Corrado","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1136\/hrt.2006.101063","article-title":"Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise","volume":"94","author":"Connelly","year":"2008","journal-title":"Heart"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1373\/clinchem.2015.240796","article-title":"Biomarker changes after strenuous exercise can mimic pulmonary embolism and cardiac injury--a metaanalysis of 45 studies","volume":"61","author":"Kayvanpour","year":"2015","journal-title":"Clin. Chem."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"3012","DOI":"10.1016\/j.mayocp.2021.05.028","article-title":"U-Shaped Association Between Duration of Sports Activities and Mortality: Copenhagen City Heart Study","volume":"96","author":"Schnohr","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_95","unstructured":"Agarwal, N., Thakkar, R., and Than, K. (2024). Sports-Related Head Injury, American Association of Neurological Surgeons."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e13933","DOI":"10.1111\/apha.13933","article-title":"Neurovascular hypoxia after mild traumatic brain injury in juvenile mice correlates with heart\u2013brain dysfunctions in adulthood","volume":"238","author":"Leyba","year":"2023","journal-title":"Acta Physiol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s12028-023-01777-3","article-title":"Cardiac Injury After Traumatic Brain Injury: Clinical Consequences and Management","volume":"40","author":"Coppalini","year":"2024","journal-title":"Neurocrit Care"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2119\/2007-00105.Flierl","article-title":"Catecholamines\u2014Crafty Weapons in the Inflammatory Arsenal of Immune\/Inflammatory Cells or Opening Pandora\u2019s Box?","volume":"14","author":"Flierl","year":"2008","journal-title":"Mol. Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/CRD.0000000000000167","article-title":"Brain-Heart Interactions in Traumatic Brain Injury","volume":"25","author":"Goyal","year":"2017","journal-title":"Cardiol. Rev."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s11910-024-01382-7","article-title":"Immune Response in Traumatic Brain Injury","volume":"24","author":"Olivella","year":"2024","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s13054-017-1620-6","article-title":"Catecholamines as outcome markers in isolated traumatic brain injury: The COMA-TBI study","volume":"21","author":"Rizoli","year":"2017","journal-title":"Crit. Care"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"113080","DOI":"10.1016\/j.expneurol.2019.113080","article-title":"Neural-respiratory inflammasome axis in traumatic brain injury","volume":"323","author":"Kerr","year":"2020","journal-title":"Exp. Neurol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e229478","DOI":"10.1001\/jamanetworkopen.2022.9478","article-title":"Association of Traumatic Brain Injury with the Risk of Developing Chronic Cardiovascular, Endocrine, Neurological, and Psychiatric Disorders","volume":"5","author":"Izzy","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Sudhakar, S.K., Sridhar, S., Char, S., Pandya, K., and Mehta, K. (2023). Prevalence of comorbidities post mild traumatic brain injuries: A traumatic brain injury model systems study. Front. Hum. Neurosci., 17.","DOI":"10.3389\/fnhum.2023.1158483"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"101652","DOI":"10.1016\/j.rehab.2022.101652","article-title":"Changes in the cardiac autonomic control system during rehabilitation in children after severe traumatic brain injury","volume":"66","author":"Sorek","year":"2023","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Arakaki, X., Arechavala, R.J., Choy, E.H., Bautista, J., Bliss, B., Molloy, C., Wu, D.A., Shimojo, S., Jiang, Y., and Kleinman, M.T. (2023). The connection between heart rate variability (HRV), neurological health, and cognition: A literature review. Front. Neurosci., 17.","DOI":"10.3389\/fnins.2023.1055445"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"39","DOI":"10.5853\/jos.2022.02173","article-title":"The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy\u2014A Review","volume":"25","year":"2023","journal-title":"J. Stroke"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s12028-023-01725-1","article-title":"Crosstalk Between the Nervous System and Systemic Organs in Acute Brain Injury","volume":"40","author":"Battaglini","year":"2024","journal-title":"Neurocrit. Care"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1007\/s40279-019-01122-9","article-title":"Physical Activity Intolerance and Cardiorespiratory Dysfunction in Patients with Moderate-to-Severe Traumatic Brain Injury","volume":"49","author":"Hamel","year":"2019","journal-title":"Sports Med."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1089\/neu.2008.0586","article-title":"Classification of Traumatic Brain Injury for Targeted Therapies","volume":"25","author":"Saatman","year":"2008","journal-title":"J. Neurotrauma"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S1474-4422(17)30371-X","article-title":"Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research","volume":"16","author":"Maas","year":"2017","journal-title":"Lancet Neurol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1136\/bjsports-2023-106898","article-title":"Consensus statement on concussion in sport: The 6th International Conference on Concussion in Sport\u2013Amsterdam, October 2022","volume":"57","author":"Patricios","year":"2023","journal-title":"Br. J. Sports Med."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","article-title":"Consensus statement on concussion in sport\u2014The 5th international conference on concussion in sport held in Berlin, October 2016","volume":"51","author":"McCrory","year":"2017","journal-title":"Br. J. Sports Med."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.csm.2010.08.006","article-title":"The epidemiology of sport-related concussion","volume":"30","author":"Daneshvar","year":"2011","journal-title":"Clin. Sports Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e461","DOI":"10.1097\/JSM.0000000000001018","article-title":"The Effect of Sex, Sport, and Preexisting Histories on Baseline Concussion Test Performance in College Lacrosse and Soccer Athletes","volume":"32","author":"Mihalik","year":"2022","journal-title":"Clin. J. Sport Med."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Kwon, J., and Jang, J. (2024). Factors Influencing Injury Severity and Frequency among Korean Sports Participants in Their 20s and 30s. Healthcare, 12.","DOI":"10.3390\/healthcare12060664"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s40798-025-00834-9","article-title":"The Incidence of Sports-Related Concussion in Children and Adolescents: A Systematic Review and Meta-Analysis","volume":"11","author":"Ingram","year":"2025","journal-title":"Sports Med. Open"},{"key":"ref_118","unstructured":"Younger, D.S. (2023). Mild traumatic brain injury and sports-related concussion. Handbook of Clinical Neurology, Elsevier. Chapter 24."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"2902","DOI":"10.1177\/03635465241270289","article-title":"Orthostatic Vital Signs After Sport-Related Concussion: A Cohort Study","volume":"52","author":"Sas","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1080\/15438627.2022.2102918","article-title":"Cardiac cycle timing and contractility following acute sport-related concussion","volume":"32","author":"Singh","year":"2024","journal-title":"Res. Sports Med."},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Kennedy, C.M., Burma, J.S., and Smirl, J.D. (2024). Sensor-Assisted Analysis of Autonomic and Cerebrovascular Dysregulation following Concussion in an Individual with a History of Ten Concussions: A Case Study. Sensors, 24.","DOI":"10.3390\/s24134404"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"101717","DOI":"10.1016\/j.jacadv.2025.101717","article-title":"Concussions Are Associated with Increases in Blood Pressure and Cardiovascular Risk in American-Style Football Athletes","volume":"4","author":"Rim","year":"2025","journal-title":"JACC Adv."},{"key":"ref_123","first-page":"205","article-title":"Sudden Cardiac Arrest in Athletic Medicine","volume":"36","author":"Terry","year":"2001","journal-title":"J. Athl. Train"},{"key":"ref_124","first-page":"e0443","article-title":"Hemodynamic Patterns Before Inhospital Cardiac Arrest in Critically Ill Children: An Exploratory Study","volume":"3","author":"Erez","year":"2021","journal-title":"Crit. Care Explor."},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Dostal, J., Hybska, T., Saganelidze, K., Pudil, R., and Stasek, J. (2024). Autonomic dysfunction as a possible cause of sudden cardiac death in swimming sports. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1443214"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1161\/CIRCULATIONAHA.122.063767","article-title":"Association Between Concussion Burden During Professional American-Style Football and Postcareer Hypertension","volume":"147","author":"Grashow","year":"2023","journal-title":"Circulation"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1002\/acn3.52045","article-title":"Concussion burden and later-life cardiovascular risk factors in former professional American-style football players","volume":"11","author":"Tan","year":"2024","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Singh, J. (2023). Repeated concussions can alter heart activity and impact the \u2018heart-brain\u2019 axis. Conversat. Can. Ed.","DOI":"10.64628\/AAM.c7y3mvdka"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s10286-023-00937-x","article-title":"Autonomic dysfunction and exercise intolerance in concussion: A scoping review","volume":"33","author":"Pelo","year":"2023","journal-title":"Clin. Auton. Res."},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"Doucet, M., Brisebois, H., and McKerral, M. (2023). Heart Rate Variability in Concussed College Athletes: Follow-Up Study and Biological Sex Differences. Brain Sci., 13.","DOI":"10.3390\/brainsci13121669"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.1177\/03635465241254527","article-title":"Latent Profiles of Acute Symptoms, Cognitive Performance, and Balance in Sport-Related Concussions","volume":"52","author":"Simons","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_132","first-page":"e55634","article-title":"Refractory Autonomic Instability in Mild Traumatic Brain Injury: A Case Report","volume":"16","author":"Siegel","year":"2024","journal-title":"Cureus"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1161\/HYPERTENSIONAHA.106.076083","article-title":"Arterial Chemoreceptors and Sympathetic Nerve Activity","volume":"50","author":"Schultz","year":"2007","journal-title":"Hypertension"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"235","DOI":"10.30773\/pi.2017.08.17","article-title":"Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature","volume":"15","author":"Kim","year":"2018","journal-title":"Psychiatry Investig."},{"key":"ref_135","doi-asserted-by":"crossref","unstructured":"Soda, T., Pasqua, T., De Sarro, G., and Moccia, F. (2024). Cognitive Impairment and Synaptic Dysfunction in Cardiovascular Disorders: The New Frontiers of the Heart-Brain Axis. Biomedicines, 12.","DOI":"10.3390\/biomedicines12102387"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1007\/s11886-023-01990-8","article-title":"The Brain\u2013Heart Axis: Neuroinflammatory Interactions in Cardiovascular Disease","volume":"25","author":"Hu","year":"2023","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1038\/s41593-023-01377-6","article-title":"Heart failure-induced cognitive dysfunction is mediated by intracellular Ca2+ leak through ryanodine receptor type 2","volume":"26","author":"Dridi","year":"2023","journal-title":"Nat. Neurosci."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1093\/qjmed\/hcad179","article-title":"Heart failure and the heart\u2013brain axis","volume":"116","author":"Doehner","year":"2023","journal-title":"QJM Int. J. Med."},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Liu, J., Xiao, G., Liang, Y., He, S., Lyu, M., and Zhu, Y. (2024). Heart-brain interaction in cardiogenic dementia: Pathophysiology and therapeutic potential. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1304864"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/B978-0-444-63600-3.00004-0","article-title":"Neurocardiology","volume":"140","author":"Osteraas","year":"2017","journal-title":"Handb. Clin. Neurol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1161\/CIRCRESAHA.125.325580","article-title":"Neural Mechanisms in Cardiovascular Health and Disease","volume":"136","author":"Ziegler","year":"2025","journal-title":"Circ. Res."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"4899688","DOI":"10.1155\/2021\/4899688","article-title":"Cognitive Dysfunction after Heart Disease: A Manifestation of the Heart-Brain Axis","volume":"2021","author":"Xu","year":"2021","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_143","doi-asserted-by":"crossref","unstructured":"Wang, M., Xu, B., Hou, X., Shi, Q., Zhao, H., Gui, Q., Wu, G., Dong, X., Xu, Q., and Shen, M. (2023). Altered brain networks and connections in chronic heart failure patients complicated with cognitive impairment. Front. Aging Neurosci., 15.","DOI":"10.3389\/fnagi.2023.1153496"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"4661","DOI":"10.12998\/wjcc.v12.i21.4661","article-title":"Predicting depression in patients with heart failure based on a stacking model","volume":"12","author":"Jiang","year":"2024","journal-title":"World J. Clin. Cases"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1093\/eurheartj\/ehab061","article-title":"Heart failure, cognition, and brain damage","volume":"42","author":"Villringer","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"e02176","DOI":"10.1002\/brb3.2176","article-title":"Cerebral blood flow impairment and cognitive decline in heart failure","volume":"11","author":"Ovsenik","year":"2021","journal-title":"Brain Behav."},{"key":"ref_147","doi-asserted-by":"crossref","unstructured":"David, H., Ughetto, A., Gaudard, P., Plawecki, M., Paiyabhroma, N., Zub, E., Colson, P., Richard, S., Marchi, N., and Sicard, P. (2020). Experimental Myocardial Infarction Elicits Time-Dependent Patterns of Vascular Hypoxia in Peripheral Organs and in the Brain. Front. Cardiovasc. Med., 7.","DOI":"10.3389\/fcvm.2020.615507"},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1113\/JP278864","article-title":"Neuroinflammation in heart failure: New insights for an old disease","volume":"598","author":"Toledo","year":"2020","journal-title":"J. Physiol."},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Lu, Z., Teng, Y., Wang, L., Jiang, Y., Li, T., Chen, S., Wang, B., Li, Y., Yang, J., and Wu, X. (2022). Abnormalities of hippocampus and frontal lobes in heart failure patients and animal models with cognitive impairment or depression: A systematic review. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0278398"},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1161\/HYPERTENSIONAHA.123.21070","article-title":"Angiotensin II-Mediated Neuroinflammation in the Hippocampus Contributes to Neuronal Deficits and Cognitive Impairment in Heart Failure Rats","volume":"80","author":"Althammer","year":"2023","journal-title":"Hypertension"},{"key":"ref_151","doi-asserted-by":"crossref","unstructured":"Hagena, H., and Manahan-Vaughan, D. (2024). Interplay of hippocampal long-term potentiation and long-term depression in enabling memory representations. Philos. Trans. R Soc. B Biol. Sci., 379.","DOI":"10.1098\/rstb.2023.0229"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1161\/CIRCRESAHA.119.315813","article-title":"Brain Damage with Heart Failure","volume":"126","author":"Mueller","year":"2020","journal-title":"Circ. Res."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1001\/jamaneurol.2023.1331","article-title":"Association Between Acute Myocardial Infarction and Cognition","volume":"80","author":"Johansen","year":"2023","journal-title":"JAMA Neurol."},{"key":"ref_154","doi-asserted-by":"crossref","unstructured":"Thong, E.H.E., Quek, E.J.W., Loo, J.H., Yun, C.Y., Teo, Y.N., Teo, Y.H., Leow, A.S.T., Li, T.Y.W., Sharma, V.K., and Tan, B.Y.Q. (2023). Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review. Biology, 12.","DOI":"10.3390\/biology12081154"},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.3233\/JAD-230886","article-title":"Communication Regarding the Myocardial Ischemia\/Reperfusion and Cognitive Impairment: A Narrative Literature Review","volume":"97","author":"Chang","year":"2024","journal-title":"J. Alzheimer\u2019s Dis."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1007\/s11886-020-01318-w","article-title":"Heart and Brain: Complex Relationships for Left Ventricular Dysfunction","volume":"22","author":"Daniele","year":"2020","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"H2264","DOI":"10.1152\/ajpheart.01072.2003","article-title":"Acute myocardial infarction induces hypothalamic cytokine synthesis","volume":"286","author":"Francis","year":"2004","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.bbi.2014.02.006","article-title":"In-depth conversation: Spectrum and kinetics of neuroimmune afferent pathways","volume":"40","author":"Quan","year":"2014","journal-title":"Brain Behav. Immun."},{"key":"ref_159","first-page":"e57159","article-title":"Neurological Consequences of Cardiac Arrhythmias: Relationship Between Stroke, Cognitive Decline, and Heart Rhythm Disorders","volume":"16","author":"Srinivas","year":"2024","journal-title":"Cureus"},{"key":"ref_160","first-page":"euae279","article-title":"Ventricular arrhythmias in association with athletic cardiac remodelling","volume":"26","author":"Claessen","year":"2024","journal-title":"EP Eur."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.1016\/j.hrthm.2024.05.018","article-title":"2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play","volume":"21","author":"Lampert","year":"2024","journal-title":"Heart Rhythm"},{"key":"ref_162","first-page":"1401","article-title":"The athlete\u2019s heart is a proarrhythmic heart, and what that means for clinical decision making","volume":"20","author":"Heidbuchel","year":"2017","journal-title":"EP Eur."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s11357-024-01290-1","article-title":"The role of atrial fibrillation in vascular cognitive impairment and dementia: Epidemiology, pathophysiology, and preventive strategies","volume":"47","author":"Fekete","year":"2024","journal-title":"Geroscience"},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.tcm.2023.01.005","article-title":"Atrial fibrillation and the risk of early-onset dementia and cognitive decline: An updated review","volume":"34","author":"Kogelschatz","year":"2024","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_165","doi-asserted-by":"crossref","unstructured":"Yong, J., and Song, J. (2024). CaMKII activity and metabolic imbalance-related neurological diseases: Focus on vascular dysfunction, synaptic plasticity, amyloid beta accumulation, and lipid metabolism. Biomed. Pharmacother., 175.","DOI":"10.1016\/j.biopha.2024.116688"},{"key":"ref_166","doi-asserted-by":"crossref","unstructured":"Song, J. (2023). Amygdala activity and amygdala-hippocampus connectivity: Metabolic diseases, dementia, and neuropsychiatric issues. Biomed. Pharmacother., 162.","DOI":"10.1016\/j.biopha.2023.114647"},{"key":"ref_167","doi-asserted-by":"crossref","unstructured":"Kouvari, M., D\u2019Cunha, N.M., Travica, N., Sergi, D., Zec, M., Marx, W., and Naumovski, N. (2022). Metabolic Syndrome, Cognitive Impairment and the Role of Diet: A Narrative Review. Nutrients, 14.","DOI":"10.3390\/nu14020333"},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"e030780","DOI":"10.1161\/JAHA.123.030780","article-title":"Cardiovascular Disease and Alzheimer\u2019s Disease: The Heart-Brain Axis","volume":"12","author":"Saeed","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_169","doi-asserted-by":"crossref","unstructured":"Zedde, M., and Pascarella, R. (2024). The Cerebrovascular Side of Plasticity: Microvascular Architecture across Health and Neurodegenerative and Vascular Diseases. Brain Sci., 14.","DOI":"10.3390\/brainsci14100983"},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1002\/ana.21377","article-title":"Body mass index and magnetic resonance markers of brain integrity in adults","volume":"63","author":"Gazdzinski","year":"2008","journal-title":"Ann. Neurol."},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1038\/nrg2468","article-title":"Metabolic syndrome: From epidemiology to systems biology","volume":"9","author":"Lusis","year":"2008","journal-title":"Nat. Rev. Genet."},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1038\/sj.ijo.0801536","article-title":"Mechanism for obesity-induced increase in myocardial lipid peroxidation","volume":"25","author":"Vincent","year":"2001","journal-title":"Int. J. Obes. Relat. Metab. Disord."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/S0014-5793(03)00875-5","article-title":"Lipid peroxidation in skeletal muscle of obese as compared to endurance-trained humans: A case of good vs. bad lipids?","volume":"551","author":"Russell","year":"2003","journal-title":"FEBS Lett."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"e13423","DOI":"10.1016\/j.heliyon.2023.e13423","article-title":"Disrupted resting-state functional connectivity of the thalamus in patients with coronary heart disease","volume":"9","author":"Wei","year":"2023","journal-title":"Heliyon"},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1093\/eurheartj\/ehac521","article-title":"Coronary microvascular dysfunction is associated with impaired cognitive function: The Cerebral-Coronary Connection study (C3 study)","volume":"44","author":"Travieso","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1111\/j.1532-5415.2011.03839.x","article-title":"Coronary artery disease is associated with cognitive decline independent of changes on magnetic resonance imaging in cognitively normal elderly adults","volume":"60","author":"Zheng","year":"2012","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1080\/09297049.2023.2170340","article-title":"Functional brain connectivity after corrective cardiac surgery for critical congenital heart disease: A preliminary near-infrared spectroscopy (NIRS) report","volume":"29","author":"Fourdain","year":"2023","journal-title":"Child Neuropsychol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7712\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:48:28Z","timestamp":1761889708000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7712"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":177,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217712"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217712","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}