Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection

Daniels, Curt J.; Rajpal, Saurabh; Greenshields, Joel T.; Rosenthal, Geoffrey L.; Chung, Eugene H.; Terrin, Michael; Jeudy, Jean; Mattson, Scott E.; Law, Ian H.; Borchers, James; Kovacs, Richard J.; Kovan, Jeffrey; Rifat, Sami F.; Albrecht, Jennifer S.; Bento, Ana I.; Albers, Lonnie; Bernhardt, David T.; Day, Carly; Hecht, Suzanne; Hipskind, Andrew; Mjaanes, Jeffrey M.; Olson, David P.; Rooks, Yvette L.; Somers, Emily C.; Tong, Matthew; Wisinski, Jeffrey; Womack, Jason; Esopenko, Carrie; Kratochvil, Christopher J.; Rink, Lawrence D.

doi:10.1001/jamacardio.2021.2065

Cited by 277 publications

(346 citation statements)

References 36 publications

(90 reference statements)

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“…This is in concordance with the cohort study of Daniels et al of 1597 US competitive athletes with CMR screening after COVID-19 infection. They confirmed the role of CMR imaging for the detection of clinical and subclinical myocarditis in 2.3% of college athletes after COVID-19 infection [10].…”

Section: Discussionsupporting

confidence: 54%

Focal Myocarditis after Mild COVID-19 Infection in Athletes

Nedeljković

Ostojic²,

Djordjevic‐Dikic

et al. 2021

Diagnostics

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COVID-19 infection in athletes usually has a milder course, but in the case of complications, myocarditis and even sudden cardiac death may occur. We examined an athlete who felt symptoms upon returning to training after asymptomatic COVID-19 infection. Physical, laboratory, and echocardiography findings were normal. The cardiopulmonary exercise test was interrupted at submaximal effort due to severe dyspnea in the presence of reduced functional capacity in comparison to previous tests. Cardiac magnetic resonance (CMR) detected the focal myocarditis. After three months of recovery, CMR still revealed the presence of focal myocarditis and the persistence of decreased functional capacity. This case raises the question of screening athletes even after asymptomatic forms of COVID-19 infection.

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Section: Discussionsupporting

confidence: 54%

Focal Myocarditis after Mild COVID-19 Infection in Athletes

Nedeljković

Ostojic²,

Djordjevic‐Dikic

et al. 2021

Diagnostics

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“…In a cohort of 145 subjects, Starekova and colleagues [ 3 ] observed that only 2 athletes (1.4%) showed CMR evidence of acute inflammation. Furthermore, in a cohort performed on 1597 after COVID-19 infection, CMR screening detected 37 subjects (2.3%) with clinical and subclinical myocarditis [ 33 ], and recent data from a multi-centered prospective study reported that the prevalence of myocarditis following SARS-CoV-2 infection is about 0–5–3% and no adverse cardiac events were registered during a median follow-up of 113 days in young competitive athletes with RMN signs of myocarditis [ 34 ]. Other studies evaluating symptom persistence in adults with mild COVID-19 disease reported that, during three-to-six month follow-up palpitations, chest pain and dyspnea were present, respectively in 9, 5 and 30% of adults [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics, Exercise Capacity and Pulmonary Function in Post-COVID-19 Competitive Athletes

Komici

Bianco

Perrotta

et al. 2021

JCM

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Background: Limited evidence exists regarding adverse modifications affecting cardiovascular and pulmonary function in physical active adults affected by COVID-19, especially in athletic populations. We aimed to describe the clinical presentation of COVID-19 in a cohort of competitive athletes, as well as spirometry and echocardiography findings and cardio-respiratory performance during exercise. Methods: Twenty-four competitive athletes with COVID-19 were recruited for this study after ending self-isolation and confirmation of negative laboratory results. All athletes underwent clinical evaluation, spirometry, echocardiography and cardiopulmonary exercise testing (CPET). These data were compared to a group of healthy control athletes. Results: Anosmia was the most frequent symptom present in 70.83% patients, followed by myalgia, fatigue and ageusia. The most frequent persisting symptoms were anosmia 11 (45.83%) and ageusia 8 (33.33%). Compared to controls, COVID-19 patients presented lower FEV1%: 97.5 (91.5–108) vs. 109 (106–116) p = 0.007. Peak Oxygen Uptake (VO2) in COVID-19 patients was 50.1 (47.7–51.65) vs. 49 (44.2–52.6) in controls (p = 0.618). Conclusions: Reduced exercise capacity was not identified and pulmonary and cardiovascular function are not impaired during early recovery phase in a population of physical active adults except FEV1 reduction.

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“…The investigators found that 46% had mild to moderate symptoms of COVID-19 infection and that 54% were asymptomatic. Twelve athletes (46%) had myocardial LGE, with 4 (15%) having myocarditis-like findings on CMR ( 52 ).…”

Section: Evaluation Of Athletes After Covid-19mentioning

confidence: 99%

“…#) Patient Cohort (Cases) LGE Positive Abnormal T 1 + T 2 , Myocarditis-like Findings on CMR a LGE Pattern/Location in Patients With Myocarditis a , b Troponin in Patients With Myocarditis a ECG and TTE in Patients With Myocarditis a Pericardium Pathology n Men, % Age, y Rajpal et al ( 52 ) 26 58 19 ± 1.5 12/26 (46) 4/26 (15%) 2 asymptomatic 2 symptomatic Epicardial, segments 3 and 9 Patchy, segments 3 and 9 Patchy, segments 2, 3, 8, and 9 Linear, segments 8 and 9 No No Effusion: 2/26 (8%) in athletes with myocarditis a 54% asymptomatic, 46% mild to moderate symptoms CMR 11-53 d after positive test result Brito et al ( 54 ) 54 (48 c ) 85 19 (19-21) 1/48 (2) 0% not applicable not applicable not applicable Pericardial LGE: 19/48 (40%) Effusion: 28/48 (58%) 30% asymptomatic, 66% mild symptoms, 4% moderate symptoms CMR 27 (range 22-33) days after positive test result Małek et al ( 55 ) 26 19 24 (21-27) 1/24 (4) 0% not applicable not applicable not applicable Effusion: 2/26 (8%) …”

Section: Evaluation Of Athletes After Covid-19mentioning

confidence: 99%

Cardiovascular Magnetic Resonance for Patients With COVID-19

Petersen

Friedrich

Leiner

et al. 2022

JACC: Cardiovascular Imaging

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COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19–related myocarditis is likely infrequent, COVID-19–related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post–COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19–related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.

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Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection

Abstract: This cohort study assesses the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play.

Cited by 277 publications

References 36 publications

Focal Myocarditis after Mild COVID-19 Infection in Athletes

Focal Myocarditis after Mild COVID-19 Infection in Athletes

Clinical Characteristics, Exercise Capacity and Pulmonary Function in Post-COVID-19 Competitive Athletes

Cardiovascular Magnetic Resonance for Patients With COVID-19

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