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Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection

Our take —

This small, cross-sectional study used cardiac magnetic resonance imaging to determine whether or not competitive athletes had findings consistent with myocarditis (heart muscle inflammation) after a mild or asymptomatic SARS-CoV-2 infection. While the study found evidence of heart muscle inflammation in four of 26 participants, it is unclear if these findings are because of SARS-CoV-2 infection, or the clinical significance of the findings given the absence of post-viral symptoms or blood markers of heart disease among participants. This study does not present clear evidence to guide when athletes should return to activity after SARS-CoV-2 infection or to use cardiac MRI as a screening test in asymptomatic individuals.

Study design

Cross-Sectional

Study population and setting

This study includes 26 college athletes at the Ohio State University (Columbus, Ohio, United States) with a history of testing positive for SARS-CoV-2. Twelve of the 26 athletes reported mild symptoms, and the other 14 were asymptomatic. None of the included participants were hospitalized or required COVID-19-specific antiviral therapy. This study did not include any athletes who did not have a diagnosis of SARS-CoV-2, or any non-athletes. All participants received cardiac magnetic resonance imaging used to detect myocardial inflammation from 11 to 53 days after their positive SARS-CoV-2 test.

Summary of Main Findings

This study reported four cases of cardiac magnetic resonance imaging (MRI) findings consistent with myocarditis (inflammation of the heart muscle) findings among 26 college athletes with a history of SARS-CoV-2 infection, none of whom have symptoms of myocarditis or blood markers of heart muscle damage. It did not include cardiac MRIs from non-athlete controls or controls who did not have SARS-CoV-2. The results of this study suggest the need for more research into the prevalence and prognostic impact of abnormal CMR patterns in otherwise healthy individuals compared to those seen in competitive athletes, and a prospective study that compares baseline cardiac MRIs prior to and after infection with SARS-CoV-2.

Study Strengths

This study includes participants in an understudied population in the SARS-CoV-2 pandemic.

Limitations

The lack of cardiac MRI prior to SARS-CoV-2 infection limits our ability to determine whether these cases of myocarditis are caused by SARS-CoV-2. Furthermore, the lack of information on athletes who did not contract SARS-CoV-2 makes it difficult to compare the characteristics of cardiac MRI patterns over time in competitive athletes. The cardiac MRIs were also not performed a consistent number of days after a positive SARS-CoV-2 test, which makes it difficult to compare participants with otherwise similar characteristics to each other. Finally, this study only includes 26 participants, four of whom had cardiac MRI characteristics of myocarditis, which makes it difficult to extrapolate these findings to all athletes, especially in the absence of a control group that was not infected with SARS-CoV-2.

Value added

This study uses cardiac MRIs to visualize the hearts of competitive athletes, which could have implications for return-to-play for athletes who test positive for SARS-CoV-2 pending further investigation into baseline cardiac MRI findings in this population.

This review was posted on: 27 September 2020