SARS-CoV2 infection: functional and morphological cardiopulmonary changes in elite handball players

Abstract

There is increasing evidence of cardiac involvement post-SARS-CoV-2 infections in symptomatic as well as in oligo- and asymptomatic athletes. This study aimed to characterize the possible early effects of SARS-CoV-2 infections on myocardial morphology and cardiopulmonary function in athletes. Eight male elite handball players (27 ± 3.5 y) with past SARS-CoV-2 infection were compared with four uninfected teammates (22 ± 2.6 y). Infected athletes were examined 19 ± 7 days after the first positive PCR test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed (− 17.7% vs. − 18.1%). However, magnetic resonance imaging showed minor signs of acute inflammation/oedema in all infected athletes (T2-mapping: + 4.1 ms, p = 0.034) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (− 292 ml/min, − 7.0%), oxygen pulse (− 2.4 ml/beat, − 10.4%), and respiratory minute volume (VE) (− 18.9 l/min, − 13.8%) in athletes with a history of SARS-CoV2 infection (p < 0.05, respectively). The parameters were unchanged in the uninfected teammates. SARS-CoV2 infection caused impairment of cardiopulmonary performance during physical effort in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection with spiroergometry to identify performance limitations and to guide the return to competition.

COVID‐19 disease in professional football players: symptoms and impact on pulmonary function and metabolic power during matches

“…Specifically, players reduced their match intensity by 4.1% ± 3.5% after COVID-19. These findings confirm and extend the results of Fikenzer and colleagues (Fikenzer et al, 2021), who observed performance impairments in male elite handball players after COVID-19. Additionally, we observed that "general fatigue" and "muscle fatigue" symptoms were perceived by several players (77% and 54%, respectively) even following COVID-19, suggesting that these symptoms may have played a key role in affecting players' performance.…”

“…Fatigue symptoms could be of particular relevance in the process of RTS decision‐making, as they may negatively affect athletes’ performance, as well as increase the risk of injuries and other negative outcomes following COVID‐19. To the best of our knowledge, only one study has ever compared physical performance before and after COVID‐19 in athletes, showing decrements in peak power output during an incremental cardiopulmonary exercise test (Fikenzer et al, 2021 ). Nevertheless, future studies are needed to confirm these results and shed some light on the long‐term COVID‐19 symptoms affecting athletes.…”

“…Other COVID‐19 symptoms that should be considered for a safer RTS are those related to the lower respiratory tract (e.g., chest pain, dyspnoea and cough), as they seem to be associated with prolonged disease and delayed RTS (Hull et al, 2022 ) and to affect pulmonary function (Fikenzer et al, 2021 ). There is limited and contradictory data on the effect of COVID‐19 on pulmonary function in the athletes population.…”

“…There is limited and contradictory data on the effect of COVID‐19 on pulmonary function in the athletes population. Specifically, some studies have reported impairments in some of the spirometry measures tested following COVID‐19 (Fikenzer et al, 2021 ; Komici et al, 2021 ; Milovancev et al, 2021 ), while others have not (Gervasi et al, 2021 ; Komici et al, 2021 ). Different factors may have accounted for such discrepancies including, different types of research design used and athletes’ fitness level (Fikenzer et al, 2021 ; Gervasi et al, 2021 ; Komici et al, 2021 ; Milovancev et al, 2021 ).…”

Diagnostic evaluation and cardiopulmonary exercise test findings in young athletes with persistent symptoms following COVID-19

“…Conversely, lower peak HR on follow-up CPET is not explained by retraining, and may indicate COVID-19 impact on the autonomic response to exercise as has been suggested by others’ work in the general population 33–36 and one prior longitudinal study in variably symptomatic athletes. 19 Our results identify important directions for future in-depth work aimed at better delineating the relationships among persistent cardiopulmonary symptoms after COVID-19, detraining and retraining, and these exercise testing parameters.…”