Inflamed Hearts in Athletes Reassuringly Rare After COVID
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Cardiac involvement was rare among professional athletes whose positive COVID-19 tests prompted systematic cardiac screening, according to the largest such study to date.

The major North American professional sports leagues were among the first to return to full-scale sport activity during the COVID-19 pandemic. Given the unknown incidence of adverse cardiac sequelae after COVID-19 infection in athletes, these leagues implemented a conservative return-to-play (RTP) cardiac testing program aligned with American College of Cardiology recommendations for all athletes testing positive for COVID-19.

This study aimed to assess the prevalence of detectable inflammatory heart disease in professional athletes with prior COVID-19 infection, using current RTP screening recommendations.

This cross-sectional study reviewed RTP cardiac testing performed on professional athletes who had tested positive for COVID-19. The professional sports leagues (Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men’s and women’s National Basketball Association) implemented mandatory cardiac screening requirements for all players who had tested positive for COVID-19 prior to resumption of team-organized sports activities.

Troponin testing, electrocardiography (ECG), and resting echocardiography were performed after a positive COVID-19 test result. Interleague, deidentified cardiac data were pooled for collective analysis. Those with abnormal screening test results were referred for additional testing, including cardiac magnetic resonance imaging and/or stress echocardiography.

-- The study included 789 professional athletes (mean age, 25 years; 777 men).

-- A total of 460 athletes (58.3%) had prior symptomatic COVID-19 illness, and 329 (41.7%) were asymptomatic or paucisymptomatic (minimally symptomatic).

-- Testing was performed a mean of 19 days after a positive test result.

-- Abnormal screening results were identified in 30 athletes (3.8%; troponin, 6 athletes; ECG, 10 athletes; echocardiography, 20 athletes), necessitating additional testing; 5 athletes ultimately had cardiac magnetic resonance imaging findings suggesting inflammatory heart disease (myocarditis, 3; pericarditis, 2) that resulted in restriction from play.

-- No adverse cardiac events occurred in athletes who underwent cardiac screening and resumed professional sport participation.

Conclusively, this study provides large-scale data assessing the prevalence of relevant COVID-19–associated cardiac pathology with implementation of current RTP screening recommendations. While long-term follow-up is ongoing, few cases of inflammatory heart disease have been detected, and a safe return to professional sports activity has thus far been achieved.