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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 Cardiology ( IF 24.0 ) Pub Date : 2021-09-01 , DOI: 10.1001/jamacardio.2021.2065
Curt J Daniels 1 , Saurabh Rajpal 1 , Joel T Greenshields 2 , Geoffrey L Rosenthal 3 , Eugene H Chung 4 , Michael Terrin 3 , Jean Jeudy 3 , Scott E Mattson 5 , Ian H Law 6 , James Borchers 7 , Richard Kovacs 8 , Jeffrey Kovan 9 , Sami F Rifat 4 , Jennifer Albrecht 3 , Ana I Bento 2 , Lonnie Albers 10 , David Bernhardt 11 , Carly Day 12 , Suzanne Hecht 13 , Andrew Hipskind 14 , Jeffrey Mjaanes 15 , David Olson 13 , Yvette L Rooks 16 , Emily C Somers 4 , Matthew S Tong 1 , Jeffrey Wisinski 17 , Jason Womack 18 , Carrie Esopenko 19 , Christopher J Kratochvil 20 , Lawrence D Rink 5 ,
Affiliation  

Importance Myocarditis is a leading cause of sudden death in competitive athletes. Myocardial inflammation is known to occur with SARS-CoV-2. Different screening approaches for detection of myocarditis have been reported. The Big Ten Conference requires comprehensive cardiac testing including cardiac magnetic resonance (CMR) imaging for all athletes with COVID-19, allowing comparison of screening approaches.

Objective To determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play.

Design, Setting, and Participants Big Ten COVID-19 Cardiac Registry principal investigators were surveyed for aggregate observational data from March 1, 2020, through December 15, 2020, on athletes with COVID-19. For athletes with myocarditis, presence of cardiac symptoms and details of cardiac testing were recorded. Myocarditis was categorized as clinical or subclinical based on the presence of cardiac symptoms and CMR findings. Subclinical myocarditis classified as probable or possible myocarditis based on other testing abnormalities. Myocarditis prevalence across universities was determined. The utility of different screening strategies was evaluated.

Exposures SARS-CoV-2 by polymerase chain reaction testing.

Main Outcome and Measure Myocarditis via cardiovascular diagnostic testing.

Results Representing 13 universities, cardiovascular testing was performed in 1597 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%); 9 had clinical myocarditis and 28 had subclinical myocarditis. If cardiac testing was based on cardiac symptoms alone, only 5 athletes would have been detected (detected prevalence, 0.31%). Cardiac magnetic resonance 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 and Relevance In this cohort study of 1597 US competitive athletes with CMR screening after COVID-19 infection, 37 athletes (2.3%) were diagnosed with clinical and subclinical myocarditis. Variability was observed in prevalence across universities, and testing protocols were closely tied to the detection of myocarditis. Variable ascertainment and unknown implications of CMR findings underscore the need for standardized timing and interpretation of cardiac testing. These unique CMR imaging data provide a more complete understanding of the prevalence of clinical and subclinical myocarditis in college athletes after COVID-19 infection. The role of CMR in routine screening for athletes safe return to play should be explored further.



中文翻译:

近期感染 SARS-CoV-2 的竞技运动员临床和亚临床心肌炎的患病率:十大 COVID-19 心脏登记结果

重要性 心肌炎是竞技运动员猝死的主要原因。已知 SARS-CoV-2 会发生心肌炎症。已经报道了检测心肌炎的不同筛查方法。十大会议需要对所有患有 COVID-19 的运动员进行全面的心脏测试,包括心脏磁共振 (CMR) 成像,以便比较筛查方法。

目的 确定 COVID-19 运动员心肌炎的患病率,并比较安全重返比赛的筛查策略。

设计、设置和参与者 十大 COVID-19 心脏登记中心的主要研究者接受了调查,以获取从 2020 年 3 月 1 日到 2020 年 12 月 15 日期间 COVID-19 运动员的汇总观察数据。对于患有心肌炎的运动员,记录心脏症状的存在和心脏测试的详细信息。根据心脏症状和 CMR 结果的存在,心肌炎被分类为临床或亚临床。亚临床心肌炎根据其他检查异常分类为可能或可能的心肌炎。确定了各大学的心肌炎患病率。评估了不同筛选策略的效用。

通过聚合酶链反应测试暴露SARS-CoV-2。

主要结果和 通过心血管诊断测试测量心肌炎。

结果 代表 13 所大学,对 1597 名运动员(964 名男性 [60.4%])进行了心血管测试。37 人(包括 27 名男性)被诊断出患有 COVID-19 心肌炎(总体为 2.3%;每个项目的范围为 0%-7.6%);9例有临床心肌炎,28例有亚临床心肌炎。如果心脏测试仅基于心脏症状,则只能检测到 5 名运动员(检出率,0.31%)。所有运动员的心脏磁共振成像检测到的心肌炎(临床和亚临床)增加了 7.4 倍。27 例 (73.0%) 的随访 CMR 成像显示所有 (100%) 的 T2 升高消退,11 例 (40.7%) 的钆晚期增强。

结论和相关性 在这项针对 1597 名美国竞技运动员在 COVID-19 感染后进行 CMR 筛查的队列研究中,37 名运动员(2.3%)被诊断出患有临床和亚临床心肌炎。各大学的患病率存在​​差异,检测方案与心肌炎的检测密切相关。CMR 发现的可变确定性和未知含义强调了对心脏测试的标准化时间和解释的必要性。这些独特的 CMR 成像数据提供了对 COVID-19 感染后大学运动员临床和亚临床心肌炎患病率的更完整的了解。应进一步探讨 CMR 在运动员安全重返赛场的常规筛查中的作用。

更新日期:2021-09-13
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