SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes
Authors: Moulson Nathaniel , Petek Bradley J. , Drezner Jonathan A. , Harmon Kimberly G. , Kliethermes Stephanie A. , Patel Manesh R. , Baggish Aaron L. , Asif Irfan M. , Borchers James , Edenfield Katherine M. , Emery Michael S. , Goerl Kyle , Hainline Brian , Kim Jonathan H. , Kraus William E. , Lampert Rachel , Leiszler Matthew , Levine Benjamin D. , Martinez Matthew W. , O’Connor Francis G. , Phelan Dermot , Rink Lawrence D. , Taylor Herman A. , Ade Carl , Aiyer Aryan , Alfadhli Jarrah , Amaradio Chloe , Anderson Scott , Arlis-Mayor Stephanie , Aubry Jonathan S. , Austin Andrea , Beaver Timothy , Benitez Nicolas , Berkstresser Brant , Best Thomas M. , Bohon Tiffany , Bonnet Jonathan P. , Boyington Elizabeth , Bray James , Bryant Jenna , Carnahan Sean , Chamberlain Rachel , Charters Samantha , Churchill Timothy W. , Comeau Douglas , Cook Laura E. , Corey Deanna , Costa Amy , Crowther Marshall , Dalia Tarun , Davidson Craig , Davitt Kaitlin , De St Maurice Annabelle , Dean Peter N. , DeZenzo Katelyn , Dimitris Courtney , Doperak Jeanne , Duffaut Calvin , Fafara Craig , Fahy Katherine , Ferderber Jason , Finn Megan , Galante Angelo , Gerlt Todd , Gest Amy , Gilson Carla , Goldberger Jeffrey , Goldman Joshua , Groezinger Erich , Guin Jonathan R. , Halseth Heather , Hare Joshua , Harness Beth , Hatamiya Nicolas , Haylett Julie , Hazen Neal , Hiroi Yeun , Hockenbrock Amy , Honsvall Amanda , Hopp Jennifer , Howard Julia , Huba Samantha , Husaini Mustafa , Huston Lindsay , Hwang Calvin , Irvin Laura , Gene Iven Val , Jones Robert , Joyce Donald , Karlson Kristine , Klein Christian , Klenck Chris , Kirk Michele , Knight Jordan , Knippa Laura , Knutson Madeleine , Kovacs Louis E. , Kuscher Yumi , Kussman Andrea , Landreth Chrissy , Leu Amy , Lothian Dylan , Lowery Maureen , Lukjanczuk Andrew , MacKnight John M. , Magee Lawrence M. , Magnuson Marja-Liisa , Mares Aaron V. , Marquez Anne , McKinley Grant , Meier Megan , Miles Christopher , Miller Emily , Miller Hannah , Mitrani Raul , Myerburg Robert J. , Mytyk Greg , Narver Andrew , Nattiv Aurelia , Nur Laika , Organ Brooke E. , Pendergast Meredith , Pettrone Frank A. , Poddar Sourav K. , Priestman Diana , Quinn Ian , Reifsteck Fred , Restivo Morgan , Robinson James B. , Roe Ryan , Rosamond Thomas , Rubertino Shearer Carrie , Rueda Miguel , Sakamoto Takamasa , Schnebel Brock , Shah Ankit B. , Shahtaji Alan , Shannon Kevin , Sheridan-Young Polly , Statuta Siobhan M. , Stovak Mark , Tarsici Andrei , Taylor Kenneth S. , Terrell Kim , Thomason Matt , Tso Jason , Vigil Daniel , Wang Francis , Winningham Jennifer , Zorn Susanna T. 
Published: April 2021

Background:
Cardiac involvement among hospitalized patients with severe coronavirus disease 2019 (COVID-19) is common and associated with adverse outcomes. This study aimed to determine the prevalence and clinical implications of COVID-19 cardiac involvement in young competitive athletes.

Methods:
In this prospective, multicenter, observational cohort study with data from 42 colleges and universities, we assessed the prevalence, clinical characteristics, and outcomes of COVID-19 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020, to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible COVID-19 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Imaging Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations.

Results:
Among 19 378 athletes tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 3018 (mean age, 20 years [SD, 1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least 1 element of cardiac triad testing (12-lead ECG, troponin, transthoracic echocardiography) followed by cardiac magnetic resonance imaging (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21 of 2999 [0.7%]), cardiac troponin (24 of 2719 [0.9%]), and transthoracic echocardiography (24 of 2556 [0.9%]). Definite, probable, or possible SARS-CoV-2 cardiac involvement was identified in 21 of 3018 (0.7%) athletes, including 15 of 2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6 of 198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-CoV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15 of 119 [12.6%]) versus a primary screening CMR (6 of 198 [3.0%]). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (odds ratio, 3.1 [95% CI, 1.2, 7.7]) or at least 1 abnormal triad test result (odds ratio, 37.4 [95% CI, 13.3, 105.3]). Five (0.2%) athletes required hospitalization for noncardiac complications of COVID-19. During clinical surveillance (median follow-up, 113 days [interquartile range=90 146]), there was 1 (0.03%) adverse cardiac event, likely unrelated to SARS-CoV-2 infection.

Conclusions:
SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short-term follow-up.