Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention Leadership and Endorsed by the Society for Cardiovascular Magnetic Resonance

Abstract

The global pandemic of COVID-19 caused by infection with SARS-CoV-2 is now entering its fourth year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. Although pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play) following resolution of infection. A variety of different testing combinations that leverage ECG, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance imaging have been proposed and implemented to mitigate risk. Cardiovascular magnetic resonance in particular affords high sensitivity for myocarditis but has been employed and interpreted nonuniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to return to play. This consensus document synthesizes available evidence to contextualize the appropriate utilization of cardiovascular magnetic resonance in the return to play assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.

Radiografia E Tomografia Para Detecção, Diagnóstico E Prognóstico De Pacientes Com Covid-19: Revisão Sistemática

“…A COVID-19 é uma doença que pode ser apresentada de várias formas a depender da gravidade da doença, a infecção pelo SARS-CoV-2 pode manifestar como assintomática ou pré-sintomática, quando não há nenhum sintoma da doença, no entanto, o teste virológico é positivado; doença leve quando a patologia afeta a via respiratória superior e há alguns sintomas leves sem apresentação da falta de ar ou a imagem anormal do tórax; doença moderada tem repercussão no trato respiratória inferior na avaliação clínica ou de imagem, além de alteração da saturação (SpO 2 ≥ 94%); na doença grave a saturação é reduzida consideravelmente (SpO 2 <94%, PaO 2 /FiO 2<300 mm Hg), além do aumento da frequência respiratória (>30 respirações/min ou infiltrados pulmonares >50%); e a manifestação crítica é quando há insuficiência respiratória, choque séptico ou disfunção de múltiplos órgãos ( RUBERG et al, 2023).…”

Prevalence of Abnormal Cardiovascular Magnetic Resonance Findings in Athletes Recovered from COVID-19 Infection: A Systematic Review and Meta-Analysis

“…Consensus statements suggest the use of CMR for athletes post COVID-19 infection with abnormal initial screening [ 5 , 31 ]. Our systematic review and meta-analysis provides a scientific rationale for the current guidelines.…”

“…With the spread of the COVID-19 pandemic, concerns have been raised as to whether athletes would be at increased risk of myocardial involvement and subsequent adverse events. CMR is the gold standard technique that allows in-depth assessment of the myocardium and the diagnosis of pathological fibrosis and oedema [ 5 ]. Along with clinical evaluation and physical examination, CMR has an important role in the assessment of athletes before they return to intensive training and competitions [ 6 ].…”

Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: a 1-year follow-up CRACoV-HHS study

“…Cardiac magnetic resonance (CMR) has the unique capability of characterising myocardial tissue properties in vivo , including evaluation for myocardial oedema. Numerous studies have reported CMR abnormalities in patients who recovered from COVID-19 infection ( 9 , 16 , 26 , 27 ). A case report was published in the early period of the pandemic presenting an interesting association between elevated biomarkers of myocardial injury with generalised myocardial oedema without late gadolinium enhancement in CMR and normal echocardiogram during COVID-19 ( 26 ).…”