Over the course of the COVID-19 pandemic thus far, the global community has seen the sporting world evolve from a complete shutdown in March 2020 to the essentially complete return of live professional sporting events in the present day. This progress was in large part due to guidance from sports cardiology leaders, who quickly provided expert consensus recommendations on how to manage athletes with COVID-19^1,2 and also rapidly disseminated data on the impact of COVID-19 on young athletes.^3,4

Fortunately, rates of myocardial involvement (e.g., myocarditis, pericarditis) in young and professional athletes with COVID-19 appear to be low.^3-5 Yet widely publicized studies that used cardiac magnetic resonance imaging (CMR) sparked conversation on the value of CMR as a screening tool in this population. Most recently, in late May 2021, a study from the Big 10 COVID-19 Cardiac Registry reported relatively wide variability in clinical myocarditis prevalence based on whether CMR was included in the screening strategy of these athletes recovering from COVID-19.⁶

Considering these ongoing discussions, we published a poll to assess how our sports cardiology community is incorporating the evidence to date into their clinical practice. Specifically, we asked, "What is your initial return-to-play screening strategy for athletes who have had COVID-19?" The answers we received are below:

Although a very limited sample size, there clearly is heterogeneity in how clinicians are evaluating this athlete population. The plurality of respondents (32.6%) stated they perform symptom assessment alone, while 25.6% recommend "triad testing" (electrocardiogram, echocardiogram, troponin) in addition to symptom assessment. Only 7.0% of respondents include CMR in their initial screening strategy, though it is possible that some of those who responded "Other" may recommend CMR as well.

We have been fortunate to witness the safe return of sporting competition over the last year. With continued guidance from sports cardiology leaders and the ongoing dissemination of short- and long-term data, we anticipate the emergence of a clear, safe, and efficient return-to-play screening strategy for our athletes after COVID-19.

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.
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. 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].
4. Hendrickson BS, Stephens RE, Chang JV, et al. Cardiovascular evaluation after COVID-19 in 137 collegiate athletes: results of an algorithm-guided screening. Circulation 2021;143:1926–28.
5. 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].
6. Daniels CJ, Rajpal S, Greenshields JT, et al. Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: results from the Big Ten COVID-19 Cardiac Registry. JAMA Cardiol 2021;May 27:[Epub ahead of print].

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Pericardial Disease, Sports and Exercise Cardiology, Magnetic Resonance Imaging, Sports and Exercise and Imaging

Keywords: Sports, Athletes, COVID-19, SARS-CoV-2, Myocarditis, Troponin, Symptom Assessment, Electrocardiography, Magnetic Resonance Imaging, Pericarditis, Registries

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