An encouraging update: Professional athletes rarely develop heart inflammation after a mild COVID-19 infection

Inflammatory heart disease is quite rare among professional athletes who experience a mild or asymptomatic COVID-19 infection, according to new findings published in JAMA Cardiology.

“Athletes have a unique risk because of demands on the heart from strenuous exercise, which can increase the risk of abnormal heart rhythms in those with underlying inflammatory heart disease,” senior author David Engel, MD, a cardiologist and associate professor at medicine Columbia University Irving Medical Center in New York City, said in a prepared statement.

Engel et al. explored data from 789 athletes with a confirmed COVID-19 diagnosis. The mean age was 25 years old, and 98.5% of the athletes were men. Athletes came from a variety of North American professional sports leagues, including Major League Soccer, Major League Baseball and the National Basketball Association.

Each individual was evaluated with the same return-to-play (RTP) cardiac testing program from May to October 2020. The RTP protocol included troponin testing, electrocardiography and resting echocardiography. In any instances where there was an abnormal screening result, the patient was referred for cardiac MR imaging and/or stress echocardiography. The mean time between RTP testing and the initial COVID-19 diagnosis was 19 days.

Overall, the team reported, there were no adverse cardiac events. Abnormal results were detected in 2.5% of athletes, which meant they were then referred for the additional testing. A total of five patients—0.6% of the total cohort—ultimately showed signs of inflammatory heart disease, meaning they were restricted from returning to play at that time. For three of those patients, the findings suggested they may have myocarditis. For the other two patients, the findings suggested pericarditis.

“Our study shows that it is rare for professional athletes with mild COVID-19 to develop heart inflammation, but the risk is not zero,” Engel said in the same statement. “These findings give college and other athletic organizations some clinically relevant context to help them optimize their RTP screening protocols with a measure of confidence.”

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