Heart Damage After COVID-19 Uncommon in College Athletes

Research highlights:

In a small study, 82% of college athletes with COVID-19 had symptoms, the majority of which were mild and did not require treatment. Further cardiac MRI screening of the 4% of athletes identified with heart defects found no heart damage or inflammation. All athletes resumed regular training and competition without problems after recovery from COVID-19.

In a small study, researchers found that college athletes who contracted COVID-19 rarely had cardiac complications. Most had mild COVID symptoms that did not require treatment, and in a small percentage of those with abnormal cardiac tests, there was no evidence of heart damage on special imaging tests. According to new research published today in the American Heart Association’s flagship magazine, Circulation, all athletes have returned to exercising without any health concerns.

In the spring of 2020, concerns about heart damage, especially inflammation, in athletes with COVID-19 led to recommendations for cardiac screening based on symptom severity before resuming training and competition. The recommended diagnostic test for heart inflammation is an MRI of the heart or cardiac magnetic resonance imaging. The standard recommendations of the Sports & Exercise Cardiology Council of the American College of Cardiology, issued in May 2020, do not recommend cardiac MRI as an initial screening test based on COVID symptoms alone, so researchers examined whether symptom severity was related to heart inflammation or poor recovery after COVID. -19.

“Our study results support an approach to cardiac screening guided by patient symptoms and COVID disease severity in accordance with current recommendations from sports cardiology groups before resuming exercise or sport,” said senior study author Ranjit R. Philip , MD, pediatric cardiologist Le Bonheur Children’s Hospital and assistant professor of pediatric cardiology at the Health Science Center at the University of Tennessee in Memphis.

From July 9, 2020 to October 21, 2020, University of Tennessee Health Sciences Center researchers reviewed medical records to identify 137 college athletes (mean age 20, 68% male) who were referred for cardiac screening to return to play after testing . positive for COVID-19. On average, the athletes were evaluated 16 days after a positive test for the COVID-19 virus. Almost half of the participants were African American students, nearly half were white students, and 7% were Hispanic students. Of the 11 sports represented at three universities, more than a third of the athletes were soccer players, followed by dance, basketball, baseball, softball, tennis, soccer, cheer, track, volleyball and golfers.

Most (82%) of the athletes had symptoms of COVID-19; the symptoms were mild for the majority (68%); and no required treatment or hospitalization. The most common symptoms were loss of smell / taste (58%), fever (less than 2 days, 42%), headache (41%) and fatigue (40%). Less commonly reported symptoms were shortness of breath (12%) and chest pain / tightness (11%). African American and Hispanic athletes were more likely to be symptomatic compared to White athletes (86% and 100% vs. 75%, respectively). No differences in symptoms or severity were found based on gender or sport.

All athletes underwent initial cardiac imaging studies, including heart ultrasound and electrocardiogram to screen for possible heart damage, and received a blood test (troponin level). Troponin is a protein released into the blood and found in the muscles of the heart when there is heart damage. Only participants with abnormal test results received a cardiac MRI.

Researchers found:

Less than 4% (5) of the 137 athletes showed heart defects on the initial screening tests. On further cardiac MRI screening of the 5 identified athletes, no heart damage or inflammation was found. After COVID-19 recovery, all athletes were able to resume their full training and competition regimens without complications.

“We were encouraged to find so few abnormal tests in these athletes, as well as negative cardiac MRIs in those who had an abnormal test during the initial screening, and no athlete had any problems after returning to sports and sports,” said Benjamin S Hendrickson, MD, co-author and pediatric and congenital cardiologist at Le Bonheur Children’s Hospital and assistant professor of pediatrics (cardiology) at the University of Tennessee Health Science Center.

“Our findings can provide reassurance to high school athletes, coaches and parents where resources for testing may be limited,” added Philip.

Limitations that could have influenced the results of the study include the lack of a control group without COVID-19 and the use of a regular as opposed to the high-sensitivity troponin test.

The new study by Dr. Philip and colleagues also confirm recent research published April 17 in Circulation that showed no adverse cardiac events related to SARS-CoV-2 infections in more than 3,000 peer athletes during short-term clinical surveillance. The findings also suggested a safe return to the game without heart tests for asymptomatic or mildly symptomatic athletes.

Other efforts to track how COVID-19 affects college athletes include an initiative by the American Heart Association and the American Medical Society for Sports Medicine (AMSSM) to accelerate a critical new research initiative studying heart disease in athletes. The collaborative data registry, started in January 2021, supports research on COVID-19 and will, over the long term, develop a deep knowledge base on heart disease in athletes after the pandemic.

Reference: May 10, 2021, Edition.
DOI: 10.1161 / CIRCULATIONAHA.121.053982

Other co-authors are Ryan E. Stephens, NP-C, MBA; James V. Chang, MD; Jacob M. Amburn, MS; Lindsey L. Pierotti, RD; Jessica L. Johnson, RN; John C. Hyden, MD; and Jason N. Johnson, MD, MHS Author disclosures are listed in the manuscript.

The study did not receive any external funding.