Is cardiac involvement prevalent in highly trained athletes after SARS-CoV-2 infection? A cardiac magnetic resonance study using sex-matched and age-matched controls

Abstract

ObjectivesTo investigate the cardiovascular consequences of SARS-CoV-2 infection in highly trained, otherwise healthy athletes using cardiac magnetic resonance (CMR) imaging and to compare our results with sex-matched and age-matched athletes and less active controls.MethodsSARS-CoV-2 infection was diagnosed by PCR on swab tests or serum immunoglobulin G antibody tests prior to a comprehensive CMR examination. The CMR protocol contained sequences to assess structural, functional and tissue-specific data.ResultsOne hundred forty-seven athletes (94 male, median 23, IQR 20–28 years) after SARS-CoV-2 infection were included. Overall, 4.7% (n=7) of the athletes had alterations in their CMR as follows: late gadolinium enhancement (LGE) showing a non-ischaemic pattern with or without T2 elevation (n=3), slightly elevated native T1 values with or without elevated T2 values without pathological LGE (n=3) and pericardial involvement (n=1). Only two (1.4%) athletes presented with definite signs of myocarditis. We found pronounced sport adaptation in both athletes after SARS-CoV-2 infection and athlete controls. There was no difference between CMR parameters, including native T1 and T2 mapping, between athletes after SARS-CoV-2 infection and the matched athletic groups. Comparing athletes with different symptom severities showed that athletes with moderate symptoms had slightly greater T1 values than athletes with asymptomatic and mildly symptomatic infections (p<0.05). However, T1 mapping values remained below the cut-off point for most patients.ConclusionAmong 147 highly trained athletes after SARS-CoV-2 infection, cardiac involvement on CMR showed a modest frequency (4.7%), with definite signs of myocarditis present in only 1.4%. Comparing athletes after SARS-CoV-2 infection and healthy sex-matched and age-matched athletes showed no difference between CMR parameters, including native T1 and T2 values.

Cardiac involvement in coronavirus disease 2019 assessed by cardiac magnetic resonance imaging: a meta-analysis

“…Four of the studies presented two cohorts [ 8 , 10 , 21 , 31 ]; therefore, we included a total of 33 independent cohorts. Among the 29 included studies, nine were from the USA [ 8 , 15 , 20 , 22 , 24 , 32 , 36 – 38 ], six were from China [ 10 , 11 , 16 , 18 , 21 , 30 ], three each from the UK [ 19 , 22 , 26 ] and Germany [ 7 , 23 , 28 , 35 ], two each from Italy [ 9 , 27 ] and Turkey [ 29 , 31 ], and one each from Poland [ 17 ], Norway [ 34 ], Hungary [ 33 ] and Spain [ 25 ]. The publication year was 2020 or 2021 ( Table 1 ).…”

“…The publication year was 2020 or 2021 ( Table 1 ). Ten studies enrolled athletes recovered from COVID-19 [ 8 , 15 , 17 , 20 , 24 , 32 , 33 , 36 – 38 ] and one study enrolled suspected myocarditis with COVID-19 [ 9 ]. Finally, 10.462 patients with COVID-19, including 1010 non-athletes and 9.452 athletes, and 746 controls were included in our analysis.…”

“…Finally, 10.462 patients with COVID-19, including 1010 non-athletes and 9.452 athletes, and 746 controls were included in our analysis. A 1.5 T MR scanner was used in 15 studies [ 8 , 9 , 11 , 15 , 17 , 22 – 26 , 28 , 29 , 33 – 35 ] and a 3.0 T MR scanner was used in six studies [ 7 , 10 , 16 , 18 , 21 , 30 ], Both 1.5 T and 3.0 T scanners were used in one study [ 20 ] and data regarding MR scanners were not provided in seven studies [ 19 , 27 , 31 , 32 , 36 – 38 ]. As the myocardial native T1 time substantially differs between different magnetic field strengths and sequences [ 39 ], we investigated the number patients with abnormal T1 time, rather than those with absolute value of native T1 time, among the nine studies presenting the prevalence of patients with abnormal native T1 times [ 7 – 9 , 11 , 17 , 22 , 26 , 27 , 32 ].…”

COVID-19 viral infection and myocarditis in athletes: the need for caution in interpreting cardiac magnetic resonance findings

“…In a recent study in the British Journal of Sports Medicine , Szabó et al 5 provided a new piece of evidence on the true incidence of myocardial tissue abnormalities at CMR in athletes who tested positive for SARS-CoV-2. The study had many methodological strengths: a large study population; a comprehensive and updated CMR tissue characterisation protocol, including T1 and T2 mapping; the availability of a subset of athletes with both pre-COVID and post-COVID CMR studies; and the inclusion of a cohort of controls without SARS-CoV-2 infection, either athletes or non-athletes.…”

Exercise-induced cardiac troponin T release in veteran athletes recovered from COVID-19

“… 8 , 9 Furthermore, a controlled cardiac magnetic resonance (CMR) study found definite signs of myocarditis in only 1.4% of athletes. 10 In addition, a recent systematic review concluded that athletes have an overall low risk (0–5%) of pericardial/myocardial involvement after recovery from COVID-19. 11 However, these studies 8–11 were conducted in young athletes (20–25 years), whereas it is known that COVID-19 is most severe at higher age.…”