High Prevalence of Pericardial Involvement in College Student Athletes Recovering From COVID-19

Abstract

Objectives We sought to explore the spectrum of cardiac abnormalities in student-athletes who returned to university campus in July 2020 with an uncomplicated Coronavirus disease 2019 (COVID-19). Background There is limited information regarding cardiovascular involvement in young individuals with mild or asymptomatic COVID-19. Methods Screening echocardiograms were performed in 54 consecutive student-athletes (mean age: 19 years, 85% males) who tested positive on reverse transcription–polymerase chain reaction nasal swab testing of the upper respiratory tract or IgG antibodies against SARS-CoV-2. A sequential cardiac magnetic resonance (CMR) imaging was performed in 48 (89%) subjects. Results A total of 16 (30%) athletes were asymptomatic while 36 (66%) and 2 (4%) reported mild and moderate COVID-19 related symptoms, respectively. For the 48 athletes completing both imaging studies, abnormal findings were identified in 27 (56.3%) individuals. This included 19 (39.5%) showing pericardial late enhancements with associated pericardial effusion. Of the individuals with pericardial enhancements, 6 (12.5%) had reduced global longitudinal strain (GLS) and/or an increased native T1. One patient showed myocardial enhancement and reduced left ventricular ejection fraction or reduced GLS with or without increased native T1 were also identified in additional 7 (14.6%) individuals. Native T2 were normal in all subjects and no specific imaging features of myocardial inflammation were identified. Hierarchical clustering of LV regional strain identified three unique myopericardial phenotypes that showed significant association with the CMR findings (P=0.03). Conclusion Over one in three previously healthy college-athletes recovering from COVID-19 infection showed imaging features of a resolving pericardial inflammation. Although subtle changes in myocardial structure and function were identified, no athlete showed specific imaging features to suggest an ongoing myocarditis. Further studies are needed to understand the clinical implications and long-term evolution of these abnormalities in uncomplicated COVID-19.

Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis

“…Mean difference between patients with poor outcome and those without (a) and adjusted OR for each 1% decrease in LV-GLS. LV-GLS, left ventricular global longitudinal strain; OR, odds ratio severity of myopericardial damages, suggesting that regional longitudinal strain is an important marker, even in asymptomatic COVID-19 patients [28]. Croft et al study showed that there was no significant difference in terms of LV-GLS in non-survivors compared to survivors, this is likely due to the high prevalence of hypertension in the patients.…”

“…Thus, reduced GLS might also be affected by acute conditions such as myopericardial damage and acute respiratory distress syndrome to other chronic causes (comorbidities) such as cardiovascular diseases, hypertension, and diabetes. A study noted that pericardial involvement was associated with lower GLS, in patients with COVID-19 [28]. Reduced GLS might be associated with the CAD coronary artery disease, CLD chronic lung disease, HF heart failure, NOS Newcastle Ottawa Scale Fig.…”

Model-based evaluation of the impact of noncompliance with public health measures on COVID-19 disease control

“…In individualistic societies, this may be accomplished by de-emphasizing altruism and focusing on the individual cost-benefit. One way this may be achieved is by emphasizing the long-term morbidity costs (such as cryptic heart, lung, brain and kidney damage) as have been documented to occur in even asymptomatic COVID-19 patients in an age-independent manner (51)(52)(53). An additional approach is to provide an accurate and current picture of the risk of contracting the disease.…”

Subclinical COVID-19 Cardiac Imaging Findings

“…In this issue of iJACC , Brito et al. ( 7 ) describe West Virginia University’s early experience with preparticipation cardiovascular screening during the COVID-19 pandemic. Among 160 student athletes returning to campus, 60 were found to have prior or active COVID-19 infection based on the results of PCR and/or IgG testing, among which 53 (37 symptomatic and 16 asymptomatic) completed further investigation to assess for myocardial and pericardial pathology.…”

“…The authors of this paper ( 7 ) are to be commended, both for the foresight to study this important issue early in the course of the COVID-19 pandemic and for their transparent reporting of a comprehensive dataset. Results from this effort will contribute to the on-going dialogue about how to protect the health of competitive athletes infected with COVD-19 in several ways.…”