Low risk for cardiac events from SARS-CoV-2 infection in youth athletes
Collegiate athletes were unlikely to develop cardiac complications from SARS-CoV-2, according to a study published in Circulation.
“Findings from this study provide an opportunity to assess and refine consensus recommendations for pre-participation cardiac screening of athletes following SARS-CoV-2 infection,” Nathaniel Moulson, MD, research fellow in medicine at Massachusetts General Hospital, and colleagues wrote.
The researchers found that 3,018 (mean age, 20 years; 32% women) of the 19,378 athletes tested positive for SARS-CoV-2. Of those, 2,820 underwent cardiac evaluation, which consisted of at least one of 12-lead ECG, troponin testing and transthoracic echocardiography (TTE), plus cardiac MRI if clinically indicated, and 198 underwent primary screening cardiac MRI.
According to the researchers, 0.7% of athletes with COVID-19 — including 0.5% of those who had clinically indicated cardiac MRI and 0.3% of those who had primary screening cardiac MRI — had definite, probable or possible cardiac involvement.
Of those who had clinically indicated cardiac MRI, 1.5% had definite or probable cardiac involvement, and of those who had cardiac MRI screening, 0.4% had definite or probable cardiac involvement, Moulson and colleagues wrote.
Among athletes in the clinically indicated cardiac MRI cohort, 17.7% of those who had at least one abnormal ECG, troponin or TTE test had definite or probable cardiac involvement, the researchers wrote.
In the cohort, 4.5% of the athletes who underwent any form of cardiac screening had abnormal testing, 2.7% had abnormal cardiac testing likely related to SARS-CoV-2 infection and 1.9% had cardiac abnormalities unrelated to SARS-CoV-2, according to the researchers.
The diagnostic yield of SARS-CoV-2 cardiac involvement for clinically indicated cardiac MRI was 12.6% compared with 3% for cardiac MRI screening, the researchers wrote.
After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (OR = 3; 95% CI, 1.2-7.7) and at least one abnormal ECG, troponin or TTE test (OR = 37.4; 95% CI, 13.3-105.3), according to the researchers.
Among the 67 athletes with one or more abnormal triad test potentially related to SARS-CoV-2, 37 underwent cardiac MRI while the remaining 30 were ultimately deemed to have isolated testing abnormalities unrelated to SARS-CoV-2, according to the researchers.
During a median follow-up of 113 days, only one athlete (0.03%) had an adverse cardiac event, which was determined to be likely unrelated to SARS-CoV-2 infection, Moulton and colleagues wrote.
“This was an amazing collaboration within the sports medicine and cardiology community. Most athletes with no symptoms or mild illness from SARS-CoV-2 can return to sports safely without additional cardiac testing as long as they feel good on return to exercise and don’t have cardiopulmonary symptoms like chest pain,” Jonathan A. Drezner, MD, director of the UW Medicine Center for Sports Cardiology in Seattle, said in a press release.
“The clinical relevance of cardiac testing abnormalities following SARS-CoV-2 infection among athletes without other clinical features of myocardial involvement requires additional study. Future studies with extended clinical follow-up and appropriate control populations including athletes without SARS-COV-2 infection are needed to better inform risk and the refinement of evidence-based screening strategies,” the researchers wrote.