Cardiac Troponin Testing as a Component of Return to Play Cardiac Screening in Young Competitive Athletes Following SARS‐CoV‐2 Infection
Authors: Moulson Nathaniel , Petek Bradley J. , Churchill Timothy W. , Drezner Jonathan A. , Harmon Kimberly G. , Kliethermes Stephanie A. , Mellacheruvu Pranav , Patel Manesh R. , Baggish Aaron L. , Asif Irfan M. , Baggish Aaron L. , Borchers James , Drezner Jonathan A. , Edenfield Katherine M. , Emery Michael S. , Goerl Kyle , Hainline Brian , Harmon Kimberly G. , Jone Pei‐Ni , Kim Jonathan H. , Kliethermes Stephanie , Kraus William E. , Lampert Rachel , Leiszler Matthew , Levine Benjamin D. , Martinez Matthew W. , Moulson Nathaniel , O'Connor Francis G. , Patel Manesh R. , Petek Bradley J. , 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 , Balcik Brenden J. , Beaver Timothy , Benitez Nicolas , Berkstresser Brant , Best Thomas M. , Bohon Tiffany , Bonnet Jonathan P. , Boyington Elizabeth , Bray James , Bryant Jenna , Bytomski Jeffrey , Carnahan Sean , Chamberlain Rachel , Charters Samantha , Chill Nicholas , Clark Daniel E. , Comeau Douglas , Cook Laura E. , Corey Deanna , Costa Amy , Crowther Marshall , Dalia Tarun , Davidson Craig , Davitt Kaitlin , De St. Maurice Annabelle , Dean Peter N. , Dendy Jeffrey M. , DeZenzo Katelyn , Dimitris Courtney , Doperak Jeanne , Duffaut Calvin , Fafara Craig , Fahy Katherine , Ferderber Jason , Finn Megan , Fish Frank A. , Fitch R. Warne , 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 , Hughes Sean G. , Hiroi Yeun , Hockenbrock Amy , Honsvall Amanda , Hopp Jennifer , Howard Julia , Huba Samantha , Husaini Mustafa , Huston Lindsay , Hwang Calvin , Irvin Laura , Iven Val Gene , Jones Robert , Joyce Donald , Karlson Kristine , Kent Jeremy , Klein Christian F. , 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 , Meester Scott , Meier Megan , Mellacheruvu Pranav , Miles Christopher , Miller Emily , Miller Hannah , Mitrani Raul , Monseau Aaron J. , Moorehead Benjamin , Myerburg Robert J. , Mytyk Greg , Narver Andrew , Nattiv Aurelia , Nur Laika , Organ Brooke E. , Pendergast Meredith , Pettrone Frank A. , Pierce Jordan , Poddar Sourav K. , Priestman Diana , Quinn Ian , Reifsteck Fred , Restivo Morgan , Robinson James B. , Roe Ryan , Rosamond Thomas , Shearer Carrie Rubertino , Riveros Diego , Rueda Miguel , Sakamoto Takamasa , Schnebel Brock , Shah Ankit B. , Shahtaji Alan , Shannon Kevin , Sheridan‐Young Polly , Soslow Jonathon H. , 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: August 2022

Background
Initial protocols for return to play cardiac testing in young competitive athletes following SARS‐CoV‐2 infection recommended cardiac troponin (cTn) to screen for cardiac involvement. This study aimed to define the diagnostic yield of cTn in athletes undergoing cardiovascular testing following SARS‐CoV‐2 infection.

Methods and Results
This prospective, observational cohort study from ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) included collegiate athletes who underwent cTn testing as a component of return to play protocols following SARS‐CoV‐2 infection. The cTn values were stratified as undetectable, detectable but within normal limits, and abnormal (>99% percentile). The presence of probable or definite SARS‐CoV‐2 myocardial involvement was compared between those with normal versus abnormal cTn levels. A total of 3184/3685 (86%) athletes in the ORCCA database met the inclusion criteria for this study (age 20±1 years, 32% female athletes, 28% Black race). The median time from SARS‐CoV‐2 diagnosis to cTn testing was 13 days (interquartile range, 11, 18 days). The cTn levels were undetectable in 2942 athletes (92%), detectable but within normal limits in 210 athletes (7%), and abnormal in 32 athletes (1%). Of the 32 athletes with abnormal cTn testing, 19/32 (59%) underwent cardiac magnetic resonance imaging, 30/32 (94%) underwent transthoracic echocardiography, and 1/32 (3%) did not have cardiac imaging. One athlete with abnormal troponin met the criteria for definite or probable SARS‐CoV‐2 myocardial involvement. In the total cohort, 21/3184 (0.7%) had SARS‐CoV‐2 myocardial involvement, among whom 20/21 (95%) had normal troponin testing.

Conclusions
Abnormal cTn during routine return to play cardiac screening among competitive athletes following SARS‐CoV‐2 infection appears to have limited diagnostic utility.