COVID-19 Linked to Myocarditis – Potentially Dangerous Heart Inflammation – In College Athletes

A small but significant percentage of college athletes with COVID-19 develop myocarditis, a potentially dangerous inflammation of the heart muscle seen only on cardiac MRI, according to a study presented today (November 29, 2021) at the annual meeting of the Radiological Society of North America (RSNA).

Myocarditis, which usually occurs as a result of a bacterial or viral infection, can affect the heart’s rhythm and ability to pump, often leaving permanent damage in the form of scarring of the heart muscle. It has been linked to as many as 20% of sudden deaths in young athletes. The COVID-19 pandemic has raised concerns about an increased incidence of the condition among student athletes.

For the new study, clinicians at schools in the highly competitive Big Ten athletics conference teamed up to collect data on the frequency of myocarditis in student athletes recovering from COVID-19 infection. Conference officials had asked all athletes who had COVID-19 to undergo a battery of heart tests before returning to play, providing researchers with a unique opportunity to collect data on the athletes’ heart status.

Jean Jeudy, MD, a professor and radiologist at the University of Maryland School of Medicine in Baltimore, is the cardiac MRI core leader for the Big Ten Cardiac Registry. This registry oversaw the collection of all data from the individual schools of the Big Ten conference.

dr. Jeudy reviewed the results of 1,597 cardiac MRI studies collected from the 13 participating schools. There was no selection bias for cardiac MRI, as all COVID-positive athletes underwent a full cardiac battery of tests, including cardiac MRI, echocardiogram, EKG, and blood work, as well as a full medical history.

Thirty-seven of the athletes, or 2.3%, were diagnosed with COVID-19 myocarditis, a rate comparable to the incidence of myocarditis in the general population. However, an alarmingly high percentage of myocarditis cases were found in athletes without clinical symptoms. Twenty of the patients with COVID-19 myocarditis (54%) had no cardiac symptoms or cardiac test abnormalities. Only cardiac MRI identified the problem.

“Testing patients for clinical signs of myocarditis captured only a small percentage of all patients with myocardial inflammation,” said Dr. jeudy. “Cardiac MRI for all athletes yielded a 7.4-fold increase in detection.”

The implications of post-COVID-19 myocardial injury detected by cardiac MRI are still unknown.

“The main issue is the presence of persistent inflammation and/or myocardial scarring,” said Dr. jeudy. “Each of these could be an underlying basis for additional damage and an increased risk of arrhythmia.”

As part of the study, Dr. Add Jeudy and colleagues to the Big Ten Cardiac Registry to gain more insight.

“We still don’t know the long-term effects,” said Dr. jeudy. “Some athletes had issues that were resolved within a month, but we also have athletes with persistent MRI abnormalities due to their initial injury and scarring. There are many chronic issues with COVID-19 that we need to know more about, and hopefully this registry can be one of the most important parts to get that information.”

The registry allows researchers to look beyond the presence of abnormalities and study things like changes in exercise function over time.

“These are young patients and the effects of myocardial inflammation could potentially have a greater impact on their lives than in older patients,” said Dr. jeudy. “That’s why we really want to push through and continue to collect this data.”

The barriers to widespread use of cardiac MRI among college athletes are significant and include the cost and lack of access to advanced MRI capabilities in many centers. But, as the new study shows, cardiac MRI adds significant value to heart testing.

“The role of cardiac MRI as a screening tool in this population needs to be explored,” said Dr. jeudy. “The reality is that there is a small percentage of cases where we know the athletes are at an increased risk of sudden death, and the use of cardiac MRI will increase the number of players identified.”

Meeting: 107th Scientific Meeting and Annual Meeting of the Radiological Society of North America