Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening | Cardiology | JAMA Cardiology | JAMA Network
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    1 Comment for this article
    What to advise on those with abnormal lab and MRI results
    John Leung, M.B.,B.S.,F.R.C.S.Ed. | Visiting consultant, Cardiothoracic Surgery, St. Paul's Hospital, Hong Kong
    Thank you for this excellent review on cardiac involvement in COVID-19 in terms of recovery and return to heavy duty competitive sports. The question remains what to advise people with abnormal cardiac test results. Do we stop them from sports until the tests return to normal or do we let them return to sports if they are symptom-free. In the latter instance do we let them have a cautious graded workup or just let them go at their own pace and preference. In particular, I would like to know the progress of the 5 athletes with MRI evidence of myo/pericarditis.
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    Original Investigation
    March 4, 2021

    Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening

    Author Affiliations
    • 1Morristown Medical Center, Atlantic Health System, Morristown, New Jersey
    • 2National Basketball Players Association, New York, New York
    • 3Major League Soccer, US
    • 4National Football League General Medical Committee, US
    • 5MedStar Sports Medicine, MedStar Union Memorial Sports Medicine, Lutherville, Maryland
    • 6Carolina Family Practice & Sports Medicine, Duke Private Diagnostic Clinic, Duke University School of Medicine, Durham, North Carolina
    • 7Major League Baseball
    • 8Division of Sports Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
    • 9National Basketball Association, US
    • 10Sports Medicine Institute, Hospital for Special Surgery, New York, New York
    • 11National Football League, US
    • 12Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
    • 13Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
    • 14Department of Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee
    • 15Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
    • 16Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
    • 17National Hockey League
    • 18Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
    • 19Division of Infectious Diseases, Toronto General Hospital, Toronto, Ontario, Canada
    • 20Division of Infectious Diseases, Weill Cornell Medical College, New York, New York
    • 21Cardiovascular Performance Program, Massachusetts General Hospital, Boston
    • 22Division of Cardiology, Columbia University Irving Medical Center, New York, New York
    JAMA Cardiol. Published online March 4, 2021. doi:10.1001/jamacardio.2021.0565
    Key Points

    Question  What is the prevalence of inflammatory heart disease identified through implementation of recent return-to-play (RTP) cardiac screening recommendations in professional athletes with prior coronavirus disease 2019 (COVID-19) infection?

    Findings  In this cross-sectional study of RTP cardiac testing performed on 789 professional athletes with COVID-19 infection, imaging evidence of inflammatory heart disease that resulted in restriction from play was identified in 5 athletes (0.6%). No adverse cardiac events occurred in the athletes who underwent cardiac screening and resumed professional sport participation.

    Meaning  Using expert consensus RTP screening recommendations for athletes testing positive for COVID-19, few cases of inflammatory heart disease were detected and safe return to professional sport activity has thus far been achieved.


    Importance  The major North American professional sports leagues were among the first to return to full-scale sport activity during the coronavirus disease 2019 (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.

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

    Design, Setting, and Participants  This cross-sectional study reviewed RTP cardiac testing performed between May and October 2020 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.

    Exposures  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.

    Main Outcomes and Measures  The prevalence of abnormal RTP test results potentially representing COVID-19–associated cardiac injury, and results and outcomes of additional testing generated by the initial screening process.

    Results  The study included 789 professional athletes (mean [SD] age, 25 [3] years; 777 men [98.5%]). 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 (SD) of 19 (17) days (range, 3-156 days) after a positive test result. Abnormal screening results were identified in 30 athletes (3.8%; troponin, 6 athletes [0.8%]; ECG, 10 athletes [1.3%]; echocardiography, 20 athletes [2.5%]), necessitating additional testing; 5 athletes (0.6%) 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.

    Conclusions and Relevance  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.