Safe return after positive test

Long-term cardiac monitoring of athletes infected with SARS-CoV-2 after resumption of top-level sport

Heart. 2023 Sep 7:heartjnl-2023-323058. doi: 10.1136/heartjnl-2023-323058. Epub ahead of print. PMID: 37678891.

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Take home message

Elite athletes with a history of COVID-19 had heart measurements comparable to those of unexposed elite athletes. Therefore, return to sports participation is safe for athletes after COVID-19.

Background

The COVID-19 pandemic created an unprecedented event that continues to have a dramatic impact on sports at all levels. Although some researchers have suggested that SARS-CoV-2 infection is associated with myocarditis, we do not fully understand the impact of SARS-CoV-2 on cardiac abnormalities in athletes.

Study Objective

The researchers used a prospective cohort study to evaluate whether SARS-CoV-2 infection can be detrimental to cardiac function and anatomy in elite athletes.

Methods

A total of 259 elite athletes participated in the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise (ELITE) cohort. All included athletes were at least 16 years old, trained more than 10 hours per week, and underwent periodic cardiovascular screenings. Of the 259 included athletes, 123 athletes had a confirmed SARS-CoV-2 infection. Those with a confirmed SARS-CoV-2 infection underwent additional cardiovascular testing, including ECG, metabolic laboratory assessment, and cardiovascular MRI. This assessment was repeated at 3, 6, and 9 months post-infection. The athletes without infection provided data from before the pandemic or self-reported no infection, which researchers confirmed with blood tests for antibodies.

Results

The authors found no differences between elite athletes with or without exposure in cardiac function or ventricular volume.

Positions

Although there are concerns about myocarditis in people exposed to SARS-CoV-2, the current study suggests that, at least in the medium term, infection is not related to persistent concerns about cardiac function or anatomy. However, more research is needed into how SARS-CoV-2 may affect cardiac function, as it remains unclear whether we can safely apply these findings to non-elite athletes.

Clinical implications

Clinicians should counsel patients that among elite athletes, it appears safe, at least in the medium term, to return to sport from a cardiac perspective. It may be helpful for patients who are not elite athletes to discuss that these findings may not apply to them. Therefore, clinicians should follow appropriate return to participation guidelines and monitor the literature.

Questions for discussion

What were your return-to-participation practices following this study? SARS-CoV-2 infection? What other considerations would you like to see in future research regarding SARS-CoV-2?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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