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Disclosures: Rajpal reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
September 11, 2020
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Assessing for myocarditis may clarify whether athletes can return to sports after COVID-19

Disclosures: Rajpal reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Cardiac MRI may help assess risk for myocarditis in athletes recovering from COVID-19 to determine whether it is safe to participate in competitive sports, researchers found.

“We don’t have any data on athletes who are recovering from COVID-19, so it adds information that was not there before,” Saurabh Rajpal, MBBS, MD, assistant professor in the department of cardiology at The Ohio State University Wexner Medical Center in Columbus, told Healio. “We have data from 26 patients who were recovering from COVID-19 [some of whom] had MRI evidence of myocarditis.”

Among athletes recovered from COVID-19, approximately 15% had cardiac MRI findings that suggested myocarditis.

In a research letter published in JAMA Cardiology, researchers performed cardiac MRIs on 26 competitive college athletes (mean age, 20 years; 58% men). All patients were referred to the sports medicine clinic after testing positive for COVID-19 between June and August.

Saurabh Rajpal

“We were getting referrals for athletes who wanted to return to play after they have recovered from COVID-19 infection,” Rajpal said in an interview. “We wanted to find out the safest way possible for them to go back to fully athletic competitive play, which is very strenuous.”

A comprehensive cardiac MRI examination, which was performed after recommended quarantine, included T1 and T2 mapping, cine, late gadolinium enhancement and extracellular volume fraction. Researchers also performed transthoracic echocardiogram, ECG and serum troponin I.

None of the patients required hospitalization or were treated with specific antiviral therapy for COVID-19. In addition, 26.9% of patients had mild symptoms during their short-term infection, and the other patients were asymptomatic.

Fifteen percent of patients, all of whom were men, had cardiac MRI findings consistent with myocarditis, which was based on two main features of the updated Lake Louise criteria: myocardial injury by the presence of nonischemic late gadolinium enhancement and myocardial edema by elevated T2 signal.

Two patients with cardiac MRI evidence of myocarditis had pericardial effusion. Of the four patients with evidence of myocardial inflammation, two had mild symptoms and two were asymptomatic.

Late gadolinium enhancement was observed in 46% of patients, of whom 30.8% had it without concomitant T2 elevation.

In patients with suspected myocarditis, the mean T2 was 59 milliseconds vs. 51 milliseconds in those without suspected myocarditis based on cardiac MRI.

“We need more research,” Rajpal told Healio. “We need more athlete scans [in patients] who had COVID-19. We also need more scans on control athletes who did not have COVID-19. [These findings] give us some pointers, but we need more data to make any concrete conclusions.”

Rajpal told Healio that he and colleagues are currently performing more cardiac MRIs in athletes who recovered from COVID-19 and in control patients so that they can be compared in a future analysis.

The debate of whether colleges should play sports during the COVID-19 pandemic has been a major topic on campuses across the U.S., including Penn State University. A recent story from CNN covered a controversy related to its director of athletic medicine citing data on how cardiac MRI identified myocarditis in 30% to 35% of Big Ten Conference athletes who recovered from COVID-19. The school later clarified that the cited information was from preliminary data shared by a colleague. The Big Ten Conference, of which Penn State University is a member, has announced that it would postpone all fall sports.

Although the study the Penn State official referenced was different from this research letter, Rajpal added that a small study like what his team conducted may not be sufficient to answer policy questions such as these.

“Our data could be one part of the whole decision-making, but it cannot be the only point on which this decision is made,” Rajpal told Healio. “Certainly, there are other factors that go into that decision than just this finding of ours in 26 athletes. We need more data to make more informed decisions.”

For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio.

Reference:

For more information:

Saurabh Rajpal, MBBS, MD, can be reached at saurabj.rajpal@osumc.edu.