Five of the 789 professional athletes infected with COVID-19 were later found to have had inflammatory heart disease in the largest study to date of the virus’s cardiac impact in sports.
In data published Thursday in JAMA Cardiology, doctors affiliated with six US-based leagues followed the 789 infected players between May and October last year.
Before returning to play, the athletes underwent three non-invasive tests that tracked heart rhythms, made an ultrasound of their hearts, and measured a protein in their blood that could signal heart damage. Thirty athletes had abnormal test results and were referred for a cardiac MRI. Doctors diagnosed five cases of inflammatory heart disease (0.6% of the total), including three cases identified as myocarditis and two as pericarditis.
Dr. David Engel, a cardiologist at Columbia University Irving Medical Center and one of the paper’s lead authors, said the results were in line with current assessments that heart injury from COVID-19 correlates with symptom severity. The study included infected athletes who were both symptomatic and asymptomatic. All five cases of heart disease included symptoms that “surpassed the empirical definitions of mild COVID-19 disease,” the paper said.
Doctors are still waiting for even larger data sets to be compiled by the Big Ten Athletic Conference and the NCAA. Individual universities have published data from their own screenings with mixed results. An Ohio State University study made headlines in the fall, when researchers found that four of 26 athletes – or 15% – had signs of myocarditis after COVID-19. A later study from the University of Wisconsin found only two cases out of 145 athletes.
Myocarditis is a rare but known effect of viral infections, including infections causing the common cold, H1N1 influenza, or mononucleosis. If left undiagnosed and untreated, it can cause heart damage and sudden cardiac arrest, which can be fatal.
Concerns about it and other heart conditions fueled early discussions about sports during the pandemic, especially last summer as it was linked to college football. Engel attributed some of those concerns to confusion over the interpretation of studies that used cardiac MRIs to identify disease.
The professional sports leagues that contributed data to the JAMA Cardiology paper – the NBA, WNBA, NFL, NHL, Major League Baseball, and Major League Soccer – followed a standardized screening procedure recommended by the American College of Cardiology. It included blood tests, an electrocardiogram, and a resting echocardiogram or heart ultrasound. Further tests and ultimately diagnosis were based on abnormalities from the initial screening.
“There was a lot of controversy about how to interpret these cardiac MRI exams and what the significance of these findings was,” Engel said. “This study had a very clinically relevant approach. Patients who tested positive underwent the recommended screening from the American College of Cardiology. Only after there were abnormalities did we proceed with testing. Using this step-by-step approach, we discovered what we considered as clinically relevant incidents of myocarditis and pericarditis, was quite low. “
Ten of the doctors involved in the study stated that they had received financial compensation or were employed by one of the involved leagues or associations. Engel is the NBA’s advisory cardiologist.
The five players diagnosed with heart disease who were not identified for the purposes of the study all had to take three to six months off exercise and will undergo further testing to determine the long-term effects of the disease on their physical bodies. state. Looking ahead, the American College of Cardiology has recommended eliminating screening for athletes with asymptomatic or mild cases, while maintaining the same screening process for those with moderate or severe symptoms.
“What was reassuring is that all the athletes who went through the screening, the 784 out of the 789, were able to achieve a safe return to the game,” Engel said. “This was unknown. At the beginning of the pandemic, when these answers were not known … we were able to demonstrate that through a rigorous and systematic approach to screening we could achieve a safe return to the game.”
In a joint statement, the six leagues said in part: “As with other lessons professional sports have learned about COVID-19, the results of this research are widely shared to continue contributing to the growing body of knowledge about the virus – a commitment that we collectively share with each other and our players for the benefit of a society that goes beyond sports. “
The study results appear to be good news for athletes suffering from COVID-19, said study co-author Dr. Jonathan Kim, a sports cardiologist at Emory University in Atlanta who also works as a team cardiologist for the Atlanta Falcons.
“All four major sports are done by 2020, they all eventually reverted to a season – including the athletes who were on this registry – and some sports like the NBA are now being carried over to a new season,” Kim told Kaiser. Health news. “Obviously, those athletes are still playing and doing well.”
The study did not shed any light on what could happen in the long term to those players who had been diagnosed with cardiac infection. They will be monitored with MRIs to see if the effects disappear over time.
“Only time will tell if we will have an epidemic of failed hearts in five years,” said Dr. Robert Bonow, a cardiologist at Northwestern University and editor of JAMA Cardiology, who was not involved in the study. “But I think that’s unlikely.”
The results of the two other upcoming studies on the possible COVID-cardiac link are expected to be published shortly, pending peer review.
ESPN’s Paula Lavigne and Mark Schlabach and Kaiser Health News reporter Markian Hawryluk contributed to this report.