Competition after COVID-19

Cardiovascular imaging demonstrated no evidence of myocardial injury or myocarditis in athletes following COVID-19 infection, according to a research letter published in Circulation by Le Bonheur Children’s Hospital and University of Tennessee Health Science Center cardiologists. The screening and evaluation was conducted by Le Bonheur Heart Institute Sports Cardiology team members Benjamin S. Hendrickson, MD, Ranjit R. Philip, MD, and Ryan E. Stephens, NP-C, MBA, and Le Bonheur Director of Cardiac MRI Jason N. Johnson, MD, MHS. Researchers say this study confirms existing recommendations that cardiovascular screening can be deferred in COVID-19 positive athletes who are asymptomatic or have milder symptoms.

Le Bonheur’s Sports Cardiology team (left to right) Ryan E. Stephens, NP-C, MBA, Jason N. Johnson, MD,
MHS, Ranjit R. Philip, MD, Ann Hyde, RN, and Benjamin S. Hendrickson, MD

“Concern for cardiovascular disease as a result of COVID-19 brought about recommendations for evaluating athletes after infection,” said Johnson. “Our results show that none of the athletes who underwent cardiac MRI had abnormal findings.”

137 collegiate athletes from three universities were evaluated in Le Bonheur’s sports cardiology clinic no sooner than 10 days after testing positive for COVID-19. The athletes, all young adults, compete across the National Collegiate Athletic Association (NCAA) Divisions 1, 2 and 3 and represent a broad range of sports and various racial ethnic backgrounds – 48% black, 47% white and 7% Hispanic.

Le Bonheur cardiologists used an algorithm-guided screening to evaluate the athletes. Regardless of symptoms or illness severity, cardiologists obtained a 12-lead electrocardiogram, transthoracic echocardiogram and conventional cardiac troponin I (cTn) level from each COVID-19 positive athlete. If any of these tests were abnormal or the athlete had a clinical evaluation of concern, they were referred for cardiac MRI (CMR). Athletes with normal evaluations and negative tests or negative CMR slowly reintroduced exercise into their routine and eventually returned to full participation in sports.

Study findings include:

• Most athletes (82%) were symptomatic and experienced mild (67%) or moderate (33%) symptoms. None of the athletes had severe COVID-19 illness.
• Only five (3.6%) athletes had abnormal testing that required CMR. Of these five, none had abnormal CMR results consistent with myocardial injury or myocarditis.
• None of the athletes experienced new symptoms or other health problems after resuming exercise and normal competition.

“On the basis of the outcomes and follow-up in our cohort, it is reasonable to defer cardiovascular screening in asymptomatic athletes or those with milder COVID-19,” said Philip. “Cardiac screening, testing and imaging can be guided by the severity of symptoms and illness in an athlete.”