A prospective study on the consequences of SARS-CoV-2 infection on the heart of young adult competitive athletes: Implications for a safe return-to-play. (1st August 2021)

• Record Type: Journal Article
• Authors: Cavigli, Luna; Frascaro, Federica; Turchini, Francesca; Mochi, Nicola; Sarto, Patrizio; Bianchi, Stefano; Parri, Antonio; Carraro, Nicolò; Valente, Serafina; Focardi, Marta; Cameli, Matteo; Bonifazi, Marco; D'Ascenzi, Flavio
• Is Part Of: International journal of cardiology. Volume 336(2021)
• Page Start: 130
• Page End: 136
• Publication Date: 2021-08-01
• Subjects: COVID-19 -- SARS-CoV-2 infection -- Myocarditis, pericarditis -- Pre-participation screening -- Return-to-play -- Athletes; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.05.042
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objectives: The COVID-19 pandemic has shocked the sports world because of the suspension of competitions and the spread of SARS-CoV-2 among athletes. After SARS-CoV-2 infection, cardio-pulmonary complications can occur and, before the resumption of sports competitions, a screening has been recommended. However, few data are available and discrepancies exist in the screening modalities. We conducted this prospective study to investigate the incidence of cardiovascular consequences following SARS-CoV-2 infection in young adult competitive athletes and the appropriate screening strategies for a safe return-to-play. Methods: Ninety competitive athletes (24 ± 10 years) after asymptomatic or mildly symptomatic SARS-CoV-2 infection were screened by physical examination, blood testing, spirometry, 12‑lead resting ECG, 24-h ambulatory ECG monitoring, echocardiogram, and cardiopulmonary exercise testing (CPET). Results: Sixty-four athletes (71.1%) were male, and most (76.7%) were mildly symptomatic. After SARS-CoV-2 infection, spirometry and resting ECG were normal in all athletes. Ambulatory ECG monitoring demonstrated <50/24 h supraventricular and ventricular premature beats in 53.3% and 52.2% of athletes, respectively, in the absence of malignant arrhythmias. CPET did not demonstrate cardiopulmonary limitations. Echocardiography showed pericardial effusion in 3 athletes (all females) with symptomatic SARS-CoV-2 infection (3.3%; 4.4% in the symptomatic group) with a definitive diagnosis of myopericarditis in 1 athlete (1.1%) and pericarditis in 2 athletes (2.2%). Conclusions: Cardiac consequences of SARS-CoV-2 infection were found in 3.3% of competitive athletes. An appropriate screening primarily based on the detection of uncommon arrhythmias and cardiac symptoms should be recommended in competitive athletes after SARS-CoV-2 infection to detect a cardiac involvement and guarantee a safe return-to-play. Highlights: After SARS-CoV-2 infection, cardio-pulmonary complications can occur. Before resumption of sports competitions, a screening before return-to-play has been recommended. A screening based on symptoms, ECG and exercise testing was able to detect cardiovascular complications. Echocardiography should be reserved to athletes with cardiac symptoms or uncommon arrhythmias. Blood testing, spirometry and CPET after asymptomatic/mildly symptomatic COVID-19 should be performed only in selected cases.