Inflammatory heart disease was rare among North American professional athletes after mild or asymptomatic COVID-19, affecting only 0.6%, according to a study published yesterday in JAMA Cardiology.
Led by researchers from Columbia University Vagelos College of Physicians and Surgeons and major North American sports leagues and players' associations, the multicenter study involved cardiac imaging of 789 pro athletes recovered from COVID-19 from May to October 2020.
Forty percent of the athletes had mild or no symptoms, and none were severely ill. None of the athletes who underwent cardiac testing and returned to play had an adverse cardiac event as of late December.
While abnormal cardiac test results were found in 3.8% of the athletes, only 5 of 789 (0.6%) were diagnosed as having inflammatory heart disease after further evaluation with cardiac magnetic resonance imaging and stress tests. The five athletes, none of whom had preexisting heart disease, were restricted from participation as a result.
'Risk is not zero'
After initial isolated reports of heart inflammation among pro athletes, all major North American professional sports leagues implemented return-to-play cardiac testing (blood tests, electrocardiography, and echocardiography) for all athletes testing positive for COVID-19, in alignment with May 2020 American College of Cardiology Sports and Exercise Cardiology Section recommendations. This study reported the results of that testing as well as information on the efficacy of the cardiac screening.
"Our study shows that it is rare for professional athletes with mild COVID-19 to develop heart inflammation, but the risk is not zero," senior study author David Engel, MD, said in in a Columbia University news release. "These findings give college and other athletic organizations some clinically relevant context to help them optimize their return-to-play screening protocols with a measure of confidence."
The researchers noted a high prevalence of cardiac injury in severely ill hospitalized COVID-19 patients but said that data were lacking on the prevalence of coronavirus-related cardiovascular dysfunction or hidden injury of the heart muscle after mild or asymptomatic infection. Differentiation of coronavirus-related cardiac dysfunction from athletic cardiac adaption (increased left-ventricular mass from regular training) has also not been fully described.
"In the absence of robust data, the optimal approach to cardiac risk stratification for athletes returning to intensive sport activity after COVID-19 infection is not known," they said in the study.
The authors said in the release that inflammatory cardiac disease involving the heart muscle or the lining of the heart caused by viral infections can trigger abnormal heart rhythms and lead to the roughly 5% of cases of sudden cardiac death in athletes. But they added that systematic cardiac return-to-play assessments of the athletes appeared effective.
"Athletes have a unique risk because of demands on the heart from strenuous exercise, which can increase the risk of abnormal heart rhythms in those with underlying inflammatory heart disease," Engel said.
The investigators called for long-term assessment of pro athletes and similar studies of pediatric, collegiate, and masters-level athletes who have recovered from COVID-19.