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

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.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.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.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.