A Special Report for ACC's Sports and Exercise Cardiology Community

Editor's Note: The following is a special report from the Chair of ACC's Sports and Exercise Cardiology Council.

As Chair of the Sport and Exercise Cardiology Leadership Council, I would like to take this opportunity to express a special thank you to all those involved with the care of the athlete. "Return to play" (RTP) has never meant more for our kids, our teams, our patients, our world, and us. The last 15 months have raised so many questions. I am grateful for the unwavering efforts of friends and colleagues to provide answers, and when none were available, our very best guidance.

The month of March is normally one of the most exciting of the sports calendar year. With the backdrop of Spring, the men's and women's NCAA basketball tourneys consume our collective consciousness. After the Ivy League canceled its men's basketball tournament on March 10, 2020, followed soon thereafter by widespread cancellations at all sporting levels, even the most fanatic sports fan could no longer ignore the seriousness of COVID-19. Initial reports drew attention to myocardial involvement by SARS-CoV-2, the virus causing COVID-19 infection. In moderately to severely ill patients, more likely older, hospitalized and affected by concomitant conditions, evidence of myocardial injury signified increased mortality. There was also early concern about the potential for myocardial injury in the asymptomatic to mildly ill patients. The early caution regarding athletes in particular centered on myocarditis, a known cause of arrhythmias and sudden death associated with exercise and unfortunately often diagnosed after the sentinel event. How often does COVID-19 cause myocarditis in athletes, the majority of whom have minimal to no symptoms, and how will this impact RTP decisions? Fortunately, multiple observational reports and datasets over the last several months have provided some reassurance, consistently reporting a <1% prevalence of clinical myocarditis.

Past and current members of our Leadership Council have taken the lead in framing RTP recommendations1-5 and the two largest reports to date on the prevalence of myocardial injury in competitive athletes.6,7 We have also hosted two COVID-19 focused webinars, one on the pediatric athlete8 and the other on the updated recommendations for RTP.9 In parallel, our ACC.org Sports and Exercise Cardiology Clinical Topic Collection, led by Dr. Jonathan H. Kim, has continued to be an outstanding "voice" for our field, producing outstanding content that is timely and original. ACC.org remains one of the best ways to actively contribute to the Sports and Exercise Cardiology Section, no matter whether you are a seasoned sports cardiologist or an FIT taking a first step into the arena.

Of course, our work is not done. The amazing development of the vaccine has given us hope that a return to in person scientific meetings, as well as fan attendance at sporting events, will soon again be the norm. The aforementioned studies in collegiate and professional athletes have helped define the scope of clinically diagnosed myocarditis.6,7 But we still have much to learn about COVID-19 and both the short- and long-term effects on athletes at every level. The role, performance, and interpretation of cardiac magnetic resonance imaging (CMR) in athletes must be refined. And we continue to be challenged everyday by patients with findings that blur the distinctions between physiology and pathology.

Finally, I would like to highlight two educational events:

  1. ACC21, May 15-17, 2021: There is a live session chaired by Drs. Aaron Baggish and Diane Polk, Session 774: Let's Get Physical! Exercise and Cardiovascular Health, on May 17. The remainder of our didactic content will be available On Demand for ACC.21 registrants beginning May 24. A link to additional sports cardiology related sessions can be found here.
  2. Care of the Athletic Heart, June 24-25, 2021. This is our showcase event led by Drs. Kim and Dermot Phelan. Registration is still open and the agenda may found here.

Care of the Athletic Heart is a great opportunity to learn from an international expert faculty about fundamental cardiovascular diagnostic and management strategies as well as the impact of COVID-19 and the athlete. The virtual program includes a combination of simulated live sessions, cases, didactics, panel discussions, live chat and Q&A opportunities. We hope you will join us!

References

  1. Phelan D, Kim JH, Chung EH. A game plan for the resumption of sport and exercise after coronavirus disease 2019 (COVID-19) infection. JAMA Cardiol 2020;5:1085-86.
  2. Kim JH, Levine BD, Phelan D, et al. Coronavirus disease 2019 and the athletic heart: emerging perspectives on pathology, risks, and return to play. JAMA Cardiol 2021;6:219-27.
  3. Phelan D, Kim JH, Elliott MD, et al. Screening of potential cardiac involvement in competitive athletes recovering from COVID-19: an expert consensus statement. JACC Cardiovasc Imaging 2020;13:2635-52.
  4. Poppas A, Chung EH, Kovacs R. COVID-19 and the athlete: gaining ground but not yet at the finish. J Am Coll Cardiol 2021;77:1368-71.
  5. Rao P, Friedman E, Chung EH, Levine BD, Isaacs SM. First responder cardiac health amid the COVID-19 pandemic. Resuscitation 2020;156:120-22.
  6. Martinez MW, Tucker AM, Bloom OJ, et al. Prevalence of inflammatory heart disease among professional athletes with prior COVID-19 infection who received systematic return-to-play cardiac screening. JAMA Cardiol 2021;Mar 4:[Epub ahead of print].
  7. Moulson N, Petek BJ, Drezner JA, et al. SARS-CoV-2 cardiac involvement in young competitive athletes. Circulation 2021;Apr 17:[Epub ahead of print].
  8. "Return to Youth Sports After COVID Infections". Webinar from American College of Cardiology. Sep 3, 2020. Accessed 05/14/2021. https://www.acc.org/education-and-meetings/meetings/meeting-items/2020/07/02/14/56/return-to-youth-sports-after-covid-infections.
  9. COVID-19 and the Athlete's Heart. Webinar from American College of Cardiology. Oct 20, 2020. Accessed 05/14/2021. https://www.acc.org/education-and-meetings/meetings/meeting-items/2020/09/22/19/18/webinar-covid-19-and-the-athletes-heart.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Magnetic Resonance Imaging, Exercise, Sports and Exercise and Imaging

Keywords: Sports, Athletes, Myocarditis, SARS-CoV-2, COVID-19, Leadership, Exercise, Magnetic Resonance Imaging, Arrhythmias, Cardiac, Vaccines


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