Vascular alterations among male elite athletes recovering from SARS-CoV-2 infection

Abstract

SARS-CoV-2 may affect the cardiovascular system and vascular impairment has been reported in healthy young adults recovering from COVID-19. However, the impact of SARS-CoV-2 infection on the vascular function of elite athletes is unknown. We examined 30 healthy male elite athletes (age 25.8 ± 4.6 years) pre-season and at a 6-month follow-up (182 ± 10 days). Vascular function and central blood pressure were calculated using transfer function-based analysis of peripheral arterial waveforms obtained by oscillometry. We performed a two-way repeated-measures ANOVA on the biomarker data, with SARS-CoV-2 status as the between-groups factor and time as the within-groups factor. Subjects who tested positive for SARS-CoV-2 were studied 18 ± 4 days after their positive testing date at follow-up. Of 30 athletes, 15 tested positive for SARS-CoV-2 after the first examination and prior to the follow-up. None had severe COVID-19 or reported any persisting symptoms. The results of the two-way repeated measures ANOVA revealed that there was no significant main effect of COVID-19 on any of the investigated biomarkers. However, there was a significant interaction between the effects of SARS-CoV-2 exposure and time on augmentation index (Aix) (p = 0.006) and augmentation index normalized to a heart rate of 75 beats per minute (Aix@75), (p = 0.0018). The observation of an interaction effect on Aix and Aix@75 in the absence of any main effect indicates a cross-over interaction. Significant vascular alterations in male elite athletes recovering from COVID-19 were observed that suggest vascular impairment. Whether these alterations affect athletic performance should be evaluated in future studies.

Cardiac Changes Related to COVID-19 in Athletes: A Brief Review

“…Comparison of vascular changes in male elite athletes recovering from COVID-19 versus uninfected individuals showed a decline of vascular and endothelial function in athletes despite the excellent fitness levels of the participants and the mild course of COVID-19 infection. These results suggest that the infection may affect not only cardiac function but may detrimentally affect aortic reservoir function, resulting in an increase in arterial stiffness, consequently, increasing cardiac work [ 3 ].…”

“…Meanwhile, the long-term COVID-19 symptoms (post-recovery) may be nonspecific and include cough, tachycardia, severe fatigue, ventricular arrhythmias, chest pain, decreased exercise tolerance and depression [ 16 ]. In terms of cardiovascular assessment, it is important to include specialized blood panel, resting electrocardiogram (ECG), 24-h ECG, echocardiogram, cardiopulmonary exercise test, assessment of flow-mediated dilation and CMR [ 3 , 4 ]. The CMR has been used to detect congestive heart failure, cardiac tamponade, and acute myocardial infarction.…”

“…Previous data suggest that athletes are susceptible to cardiovascular complications after COVID-19 infection, including myocarditis, pre-myocardial injury, increased arterial stiffness, and decreased vascular function [ 2 , 3 ], raising concern about myocardial inflammation as an additional cause of cardiac damage from COVID-19 in this population [ 4 , 5 ]. In order to face the COVID-19 spread and prevent the collapse of the health system, some rigorous strategies based on social distancing and adherence to home quarantine have been practiced worldwide.…”

A Case Series of SARS-CoV-2 Reinfection in Elite Athletes

“…As more and more data are pointing i the same direction, guidelines on a return-to-play protocol tend to be less strict in terms of cardiovascular examination of the athletes [ 26 ]. On the other hand, some authors found that COVID-19 infection might lead to mild vascular impairment, affecting athletic performance [ 27 ]. As there is a lack of data about short-term reinfection in the population of elite athletes, we believe that should not discard the importance of a return to play examination protocol.…”

Team Approach: Diagnosis, Management, and Prevention of Sudden Cardiac Arrest in the Athlete

“…Interestingly, these abnormalities have persisted on follow-up cardiac magnetic resonance imaging after COVID-19 recovery, with the most frequent cardiac changes being myocarditis, regional scar, and pericardial enhancement 21 . Furthermore, studies have shown a decline in vascular and endothelial function in infected athletes, despite excellent fitness levels and mild symptoms, suggesting that COVID-19 inoculation may affect cardiac and aortic reservoir function, which altogether can increase arterial stiffness and cardiac work 20 . How these changes fit in the context of the normal cardiac remodeling seen in athletes is not fully understood and warrants continued investigation.…”