Cardiac magnetic resonance (CMR) may provide an excellent risk stratification assessment for myocarditis in competitive athletes who have recovered from COVID-19, which could guide safe competitive sports participation, according to a study released Friday . These findings were published online Friday in JAMA Cardiology.
Myocarditis is a significant cause of sudden cardiac death in competitive athletes and can occur with normal ventricular function. Recent studies have raised concerns of myocardial inflammation after recovery from COVID-19, even in asymptomatic or mildly symptomatic patients.
Saurabh Rajpal, MBBS, MD, and colleagues, of Ohio State University, investigated the use of CMR imaging in competitive athletes who had recovered from COVID-19 to detect myocardial inflammation that would identify athletes facing high risk if they were to return to competitive play. The investigators performed a comprehensive CMR examination using standardized protocols in 26 competitive athletes (mean age, 19.5 years; 15 male [57.7%]) who were referred to the sports medicine clinic after testing positive for COVID-19 between June and August 2020 at Ohio State.
Twelve athletes reported mild symptoms during the short-term infection, while the others were asymptomatic. There were no diagnostic ST/T wave changes on electrocardiogram, and ventricular volumes and function were within the normal range in all athletes by transthoracic echocardiogram and CMR imaging. No athlete had elevated serum levels of troponin I. Four athletes (15%; all men) had CMR findings consistent with myocarditis. Pericardial effusion was present in two athletes with CMR evidence of myocarditis. Two of these four athletes with evidence of myocardial inflammation had mild symptoms (shortness of breath), while the other two were asymptomatic. Twelve athletes (46%) had late gadolinium enhancement (LGE), of whom eight (30.8%) had LGE without concomitant T2 elevation. Mean T2 in those with suspected myocarditis was 59 milliseconds compared with 51 milliseconds in those without CMR evidence of myocarditis.
Despite the small population size, and the need for longer-term following along with a control population, this study demonstrates that CMR can be used to stratify athletes with previous COVID-19 for risk of sudden cardiac death before they return to participating in competitive sports.
Rajpal S, Tong MS, Borchers J, et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiol 2020 Sep 11.