Abstract 13671: Return to Play After COVID-19 Infection in Collegiate Competitive Athletes

Abstract

Introduction: COVID-19 infection has placed significant healthcare and economic burdens on society. Recent studies of patients recovered from COVID-19 infection demonstrate highly variable rates of cardiac involvement. A German cohort reported 78% cardiac involvement as defined by abnormalities seen on cardiac magnetic resonance imaging (CMR) while more recent data suggests rates of cardiac involvement between 0.3% and 3%. Competitive athletes represent a unique population as they may pose greater risk for sudden cardiac death during competition due to myocarditis as a sequela of COVID-19 infection. Hypothesis: We hypothesize that among athletes with non-severe COVID-19 infection, a symptom driven clinical pathway would lead to a safe and cost-effective return to sports. Methods: A retrospective analysis was conducted in a cohort of collegiate athletes with non-severe COVID-19 infection returning to competitive sports. The primary outcomes were the prevalence of cardiac involvement based on symptoms and abnormalities with electrocardiograms (ECG), troponin, or transthoracic echocardiogram (TTE). CMR were performed for ongoing cardiopulmonary symptoms or abnormal cardiac test results. Evaluation for myocarditis using CMR was based on the updated Lake Louise criteria. Athletes without evidence of cardiac involvement were permitted to participate in a graduated protocol to return to play. Results: A sample size of 83 athletes (mean age 20 years; female athletes 34%) diagnosed with COVID-19 infection by PCR was analyzed. Abnormal findings suggestive of cardiac involvement were detected by symptoms [82%, Standard Error of Mean (SEM) 0.04], ECG (2.5%, SEM 0.04), troponin (0%, SEM 0), and TTE (0%, SEM 0). CMR was clinically indicated in 7 patients and there were no abnormal findings. No patients were hospitalized and during a clinical surveillance period (median follow up of 105 days), there were no adverse cardiac or non-cardiac events. Conclusions: There is a low prevalence of cardiac involvement among collegiate athletes with non-severe COVID-19 infection. In this cohort, safe progression to competitive athletics using a symptom driven clinical pathway was demonstrated in a cost-effective manner.