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

Abstract

Background There is increasing evidence of cardiac involvement in SARS-COV-2 infections. This may not only apply to symptomatic infections but may also affect asymptomatic athletes. This study aimed to characterize the possible acute cardiac involvement of SARS-COV-2 infection in athletes both morphologically and functionally. Methods and results Eight elite handball players (27±3.5 y) with past SARS-COV-2 infection were retrospectively analyzed and compared with four uninfected team-mates (22±2.6 y). Athletes were examined 19±7 d after positive PCR-test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed after SARS-CoV2 infection (−17.7% vs. −18.1%) but magnetic resonance imaging showed minor signs of acute inflammation/edema in all patients (T2-mapping: +4.1ms) 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 control group. Conclusion SARS-CoV2 infection caused functional impairment of cardiopulmonary performance primarily under stress in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection at least with spiroergometry to mark performance limitations and to ensure an optimal return to competition. FUNDunding Acknowledgement Type of funding sources: None.

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

“…Moreover, no association between days of infection and ΔFVC, ΔFEV 1 , ΔFEV 1 /FVC, and ΔPEF was observed, even though the small sample size tested ( n = 10) and a narrow range of both dependent and independent variables may have hindered some associations. These findings suggest that COVID‐19 does not considerably affect FVC, FEV 1 , FEV 1 /FVC, and PEF in athletes with mild symptoms, which is in line with previous investigations (Fikenzer et al, 2021; Milovancev et al, 2021), but in contrast with others (Gervasi et al, 2021; Komici et al, 2021). No evidence of spirometric impairments was also observed in a large cohort of healthy young adults who had mild‐to‐moderate COVID‐19 symptoms (Mogensen et al, 2022), suggesting that spirometric impairments would unlikely occur in young and healthy populations.…”

“…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.…”

“…To the best of our knowledge, our study was among the first ones investigating the effect of COVID‐19 on physical performance (Fikenzer et al, 2021). The results showed that football players expressed significantly lower metabolic power in the 10 matches played immediately after COVID‐19 compared to the 10 matches played immediately before, despite covering the same distance per time.…”

“…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). It is also worth noting that it is still unclear whether spirometry tests may be of prognostic value or should be used as predictors of respiratory symptoms following COVID‐19 in athletes.…”

“…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.…”