Is extensive cardiopulmonary screening useful in athletes with previous asymptomatic or mild SARS-CoV-2 infection?

Abstract

ObjectiveDuring the COVID-19 pandemic, it is essential to understand if and how to screen SARS-CoV-2-positive athletes to safely resume training and competitions. The aim of this study is to understand which investigations are useful in a screening protocol aimed at protecting health but also avoiding inappropriate examinations.MethodsWe conducted a cohort study of a professional soccer team that is based on an extensive screening protocol for resuming training during the COVID-19 pandemic. It included personal history, antigen swabs, blood tests, spirometry, resting/stress-test ECG with oxygen saturation monitoring, echocardiogram, Holter and chest CT. We also compared the findings with prior data from the same subjects before infection and with data from SARS-CoV-2-negative players.ResultsNone of the players had positive swab and/or anti-SARS-CoV-2 IgM class antibodies. Out of 30 players, 18 (60%) had IgG class antibodies. None had suffered severe SARS-CoV-2-related disease, 12 (66.7%) had complained of mild COVID-19-related symptoms and 6 (33.3%) were asymptomatic. None of the players we examined revealed significant cardiovascular abnormalities after clinical recovery. A mild reduction in spirometry parameters versus pre-COVID-19 values was observed in all athletes, but it was statistically significant (p<0.05) only in SARS-CoV-2-positive athletes. One SARS-CoV-2-positive player showed increased troponin I level, but extensive investigation did not show signs of myocardial damage.ConclusionIn this small cohort of athletes with previous asymptomatic/mild SARS-CoV-2 infection, a comprehensive screening protocol including blood tests, spirometry, resting ECG, stress-test ECG with oxygen saturation monitoring and echocardiogram did not identify relevant anomalies. While larger studies are needed, extensive cardiorespiratory and haematological screening in athletes with asymptomatic/mild SARS-CoV-2 infection appears unnecessary.

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

“…Although competitive athletes are usually young and healthy and may develop SARS-CoV-2 infection asymptomatically or with mild symptoms [ 2 ], concerns exist about the potential Covid-19 cardiac complications among athletes and the risk of myocardial and myopericardial involvement leading to sport-related arrhythmias and eventually sudden cardiac death (SCD). Accordingly, after SARS-CoV-2 infection and before the resumption of competitions, cardiovascular screening is recommended to exclude COVID-19-specific complications that may pose a risk to the athlete and decide whether, when and how to resume training and competitions [ [4] , [5] , [6] ]. However, uncertainties exist about the prevalence of cardiac complications after SARS-CoV-2 infection, and the optimal approach to screen competitive athletes after Covid-19 infection and different screening protocols have been recommended for a safe return to sports [ 2 , 5 , 6 ].…”

Findings from Cardiovascular Evaluation of NCAA Division I Collegiate Student-Athletes after Asymptomatic or Mildly Symptomatic SARS-CoV-2 Infection

“…A report of 30 professional soccer players screened with blood tests, spirometry, ECG, echocardiogram, and stress ECG did not identify clinically relevant anomalies. [4] Data from an Italian professional soccer team suggested a limited role for troponin post-COVID-19 infection. [21] Our data on a relatively large cohort of athletes supports these studies, suggesting a limited role for extensive evaluation in athletes who experience no symptoms or mild symptoms.…”

“…[3] However, a study of 18 professional soccer players with a previous history of asymptomatic or mildly symptomatic SARS-CoV-2 infection yielded no signs of cardiac involvement after resting and stress-test ECGs, holter monitoring, echocardiogram, chest CT, and cardiac MRI. [4] One published expert opinion on cardiac screening for return-to-play after symptomatic COVID-19 infection recommended resting ECG, troponin assay, and 2-D echocardiogram. [5] Consensus opinions were subsequently revised for the collegiate athlete population, with the recommendation for routine cardiovascular testing after mildly symptomatic infections removed.…”

“…[3] However, a study of 18 professional soccer players with a previous history of asymptomatic or mildly symptomatic SARS-CoV-2 infection yielded no signs of cardiac involvement after resting and stress-test ECGs, holter monitoring, echocardiogram, chest CT, and cardiac MRI. [4]…”

In a global pandemic, sport and exercise medicine can mean so much more

“…that in hot-humid conditions such as those anticipated in Tokyo, female athletes in particular may benefit from longer-term heat acclimation and re-acclimation to maximise performance (see page 298) 3…”