Abstract
Introduction: There is increased scrutiny on cardiac screening of competitive athletes after COVID-19 illness, and cardiac magnetic resonance (CMR) is frequently undertaken. Limited reports with echocardiography-based strain techniques suggest occult abnormalities in collegiate athletes after COVID-19. Cardiac involvement in the adolescent athlete has not been well characterized. The purpose of this study is to describe CMR findings, including strain encoded (SENC) imaging, in adolescent athletes after COVID-19 (C19+AA). Methods: Retrospective review was performed of ambulatory C19+AA patients who underwent CMR (Group A). Healthy athletes (Group B) and nonathlete healthy controls (Group C) underwent CMR with SENC for comparison. Myocardial strain was evaluated by MyoStrain (Myocardial Solutions, Morrisville, NC). LV global (GLS) and regional strain (from modified AHA-16 segment model) were compared between the three groups with abnormal defined as magnitude <17 and statistical significance set at p < 0.05. Results: Group A patients were younger (n = 87, 52% male, age 15.4±1.8 yrs) than Group B (n = 19, 63% male, age 21.3±1.6 yrs) and Group C (n = 9, 52.6% male, age 19.3±1.1 yrs) with no difference in LVEF between the three groups (Group A = 59.1±3.9%, Group B = 60.3±6.2%, Group C = 61.0±4.1%). Despite preserved global function, Group A had significantly lower GLS (-17.6±2.3% vs Group B = -20.8±1.4%, p <0.04 and Group C = -19.1±2.4%, p = 0.02) with no difference between the latter groups (p = 0.07). Higher numbers of abnormal segments were observed in Group A (6.9±3.7, 43.1%) vs Group B (2.4±1.9, p < 0.0001) and Group C (3.7±3.5, p < 0.0001) with no difference between the latter groups (p = 0.1). Conclusions: Global and regional strain abnormalities were common in C19+AA in the setting of normal LVEF. This may represent occult myocardial abnormalities in adolescents after COVID-19. Future longitudinal studies with age matched controls are needed to monitor for progression.
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