Prevalence of Myocarditis in Competitive Athletes With SARS-CoV-2

Quick Takes

  • Screening with CMR imaging increased the prevalence of clinical and subclinical myocarditis by a factor of 7.4-2.3%.
  • These CMR imaging findings provide important data on the prevalence of clinical and subclinical myocarditis in college athletes recovering from symptomatic and asymptomatic COVID-19 infections.
  • There is a need to minimize the variability among academic centers in diagnosis of myocarditis through standardized evidence-based diagnostic algorithms and testing protocols, and possibly, standardization of CMR protocols and interpretation.

Study Questions:

What is the prevalence of myocarditis in athletes with coronavirus disease 2019 (COVID-19) and screening strategies for safe return to play?

Methods:

The investigators surveyed Big Ten COVID-19 Cardiac Registry principal investigators for aggregate observational data from March 1, 2020–December 15, 2020, on athletes with COVID-19. For athletes with myocarditis, presence of cardiac symptoms and details of cardiac testing were recorded including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction testing. Myocarditis was categorized as clinical or subclinical based on the presence of cardiac symptoms and cardiac magnetic resonance (CMR) findings. Subclinical myocarditis was classified as probable or possible myocarditis based on other testing abnormalities. Myocarditis prevalence across universities was determined and the utility of different screening strategies was evaluated. The main outcome measure was myocarditis via cardiovascular diagnostic testing.

Results:

Representing 13 universities, cardiovascular testing was performed in 1,597 athletes (964 men [60.4%]). Thirty-seven (including 27 men) were diagnosed with COVID-19 myocarditis (overall 2.3%; range per program, 0-7.6%); nine had clinical myocarditis and 28 had subclinical myocarditis. If cardiac testing was based on cardiac symptoms alone, only five athletes would have been detected (detected prevalence, 0.31%). CMR imaging for all athletes yielded a 7.4-fold increase in detection of myocarditis (clinical and subclinical). Follow-up CMR imaging performed in 27 (73.0%) demonstrated resolution of T2 elevation in all (100%) and late gadolinium enhancement in 11 (40.7%).

Conclusions:

The authors concluded that in this cohort study of competitive athletes with CMR screening after COVID-19 infection, 2.3% were diagnosed with clinical and subclinical myocarditis.

Perspective:

This cohort study of 1,597 US competitive collegiate athletes undergoing comprehensive cardiovascular testing reports that the prevalence of clinical myocarditis based on a symptom-based screening strategy was only 0.31%. Screening with CMR imaging increased the prevalence of clinical and subclinical myocarditis by a factor of 7.4-2.3%. These CMR imaging findings provide important data on the prevalence of clinical and subclinical myocarditis in college athletes recovering from symptomatic and asymptomatic COVID-19 infections. Finally, there is a need to minimize the variability among academic centers in diagnosis of myocarditis through standardized evidence-based diagnostic algorithms and testing protocols, and possibly, standardization of CMR protocols and interpretation.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Acute Heart Failure, Magnetic Resonance Imaging, Sports and Exercise and Imaging

Keywords: Athletes, Contrast Media, Coronavirus, COVID-19, Diagnostic Imaging, Gadolinium, Heart Failure, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Myocarditis, Outcome Assessment, Health Care, Polymerase Chain Reaction, Primary Prevention, SARS-CoV-2, Universities


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