COVID-19 linked to hard-to-find heart inflammation among college athletes

CHICAGO, Ill. — New research suggests there may be a link between COVID-19 infections and an elevated risk of a particularly hard-to-diagnose form of myocarditis (heart inflammation) among college athletes. Study authors report that a small but significant percentage of student athletes diagnosed with COVID-19 may go on to develop heart problems.

Myocarditis usually appears due to a bacterial or viral infection and can result in an irregular heartbeat, changes to the heart’s ability to pump blood, and heart muscle scarring. Troublingly, myocarditis has a link to roughly 20 percent of all sudden deaths among young athletes.

This latest research entailed collaboration between doctors working with universities in the Big Ten athletic conference. Physicians kept track of myocarditis rates among student athletes recovering from recent COVID-19 infection. Per conference rules, all athletes recovering from a bout with COVID-19 must undergo a series of heart tests before returning to the playing field. This rule provided the research team with a unique opportunity to keep tabs on cardiac outcomes among young athletes recovering from the coronavirus.

Half of college athletes showed no signs of their heart issues

Study authors analyzed a total of 1,597 cardiac MRI exams collected across 13 schools. In addition to just a cardiac MRI, every single student athlete also underwent a full battery of additional cardiovascular tests including echocardiogram, ECG, and blood tests. Researchers also had access to each student’s complete medical history.

Among that entire sample, 37 athletes (2.3%) were diagnosed with myocarditis. While that percentage is largely consistent with myocarditis rates in the general population, researchers say they are concerned by how many student athletes had no idea about their condition. Of those 37 students, 20 (54%) showed absolutely no outward symptoms or testing “abnormalities” usually seen in non-COVID-related myocarditis cases. For these athletes, the only way of diagnosing the condition was via cardiac MRI.

“Testing patients for clinical symptoms of myocarditis only captured a small percentage of all patients who had myocardial inflammation,” explains Jean Jeudy, M.D., professor and radiologist at the University of Maryland School of Medicine in Baltimore, who served as the cardiac MRI core leader for the Big Ten Cardiac Registry, in a media release. “Cardiac MRI for all athletes yielded a 7.4-fold increase in detection.”

“The main issue is the presence of persistent inflammation and/or myocardial scar,” he adds. “Each of these can be an underlying foundation for additional damage and increased risk of arrhythmia.”

How long does this damage last?

This work is still ongoing, and Dr. Jeudy and his colleagues continue to make contributions to the Big Ten Cardiac Registry.

“We still don’t know the long-term effects,” Dr. Jeudy continues. “Some athletes had issues that resolved within a month, but we also have athletes with continued abnormalities on their MRI as a result of their initial injury and scarring. There are a lot of chronic issues with COVID-19 that we need to know more about, and hopefully this registry can be one of the major parts of getting that information.”

The registry will be an invaluable resource moving forward, as it will allow scientists to track and examine any and all changes in exercise function over time among the recovering athletes.

“These are young patients, and the effects of myocardial inflammation can potentially impact their lives more significantly than in older patients,” Dr. Jeudy comments. “That’s why we really want to push forward and continue to collect this data.”

One concerning issue is that many college athletes just don’t have access to cardiac MRIs. Study authors say this work stresses the need for greater cardiac MRI accessibility, in terms of both a lower cost and improved MRI capabilities across health and medical centers.

“The role of cardiac MRI as a screening tool in this population needs to be explored,” Dr. Jeudy concludes. “The reality is that there are a small percentage of cases where we know the athletes have an increased risk for sudden death, and using cardiac MRI will increase the number of players who are identified.”

Researchers presented their findings at the 107th Scientific Assembly and Annual Meeting of the Radiological Society of North America.

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