Abstract
Background: SARS-CoV-2 can lead to several systemic complications, including myocardial injuries; these might be worsened by heavy physical activity. The optimal approach to cardiac risk stratification following SARS-CoV-2 infection in athletes for a safe return to play (RTP) still needs defining. The aim of this study was to assess the prevalence of abnormal RTP test results, according to the protocol of Italian Federation of Sport Medicine (FMSI), which was endorsed by the Italian Ministry of Health, potentially representing COVID-19-associated cardiac injuries. Methods: This was a prospective, multicenter, observational study. All consecutive competitive athletes who underwent COVID-19 RTP testing protocol from 1 May to 31 July 2021, across 60 Italian Centers of Sports Medicine, were enrolled in the study. Athletes were tested at least 30 days after negativization of the nasopharyngeal swab (or immediately after negativization in professional athletes or Probable Olympians). A 12-lead electrocardiography at rest and during maximal incremental exercise test with continuous O2 saturation monitoring and an echocardiographic examination were part of the protocol. In athletes with “moderate” disease (NHI classification), 24 h ECG monitoring (to be performed on a training day) and Magnetic Resonance Imaging (MRI) were also performed. Results: A total of 4143 athletes (67.8% males and 32.2% females) (53% > 18 years, 20% 18–35 years and 16% > 35 years), from more than 40 different sport disciplines, were included in the study. The mean age was 22.5 ± 13.3 years, with ages ranging from 8 to 80 years. Of these athletes, 52.3% were asymptomatic, 46.4% manifested mild symptoms, 1.1% and 0.14% had moderate or severe symptoms, respectively, while critical illness was evident in one athlete. Abnormal echocardiographic findings were detected in 80 cases (1.9%), and pericarditis in 7 cases (0.2%); all were from mildly symptomatic athletes. Arrhythmic events were recorded in 239 athletes, with 224 (5.4%) in the exercise test and 15 (0.4%) during 24 h ECG monitoring. Ventricular arrhythmias were observed in 101 (2.4%) athletes from the total population (mostly isolated or couples of premature ventricular beats): 91 in the exercise test and 10 during 24 h ECG monitoring. Cardiac magnetic resonance was performed in 34 athletes; the presence of myocarditis was confirmed in 5 athletes (0.12% of the total population, 14.7% of athletes in which MRI was performed). Conclusions: According to our results, cardiac complications from SARS-CoV-2 in asymptomatic or mildly symptomatic competitive athletes are rare, and an RTP assessment based on symptoms and ECG-monitored exercise test would ensure a safe RTP in these athletes.
Highlights
Return to play (RTP) for competitive athletes infected with SARS-CoV-2 who recovered from the disease is a matter of great social interest and of health policy
[1] limited data are available regarding the prevalence of cardiac injury and its consequences among non-hospitalized individuals with SARS-CoV-2, an issue highlighted by the young age of athletes and the large absence or, at most, the presence of mild clinical symptoms
Infection from the SARS-CoV-2 virus might result in myocardial injury, which can be worsened by physical efforts, in the acute phase when viral replication can be enhanced by vigorous physical activity, resulting in greater structural damage of the heart, myocarditis
Summary
Return to play (RTP) for competitive athletes infected with SARS-CoV-2 who recovered from the disease is a matter of great social interest and of health policy. Particular concerns have been raised regarding possible adverse cardiac sequelae of SARS-CoV-2 infection [1] limited data are available regarding the prevalence of cardiac injury and its consequences among non-hospitalized individuals with SARS-CoV-2, an issue highlighted by the young age of athletes and the large absence or, at most, the presence of mild clinical symptoms. Infection from the SARS-CoV-2 virus might result in myocardial injury, which can be worsened by physical efforts, in the acute phase when viral replication can be enhanced by vigorous physical activity, resulting in greater structural damage of the heart, myocarditis. The prevalence of cardiac injury in non-hospitalized athletes is not well defined, and neither are the post-infection durations and the magnitude of possible complications. A cardiac injury from COVID-19 is defined as having high-sensitivity troponin I (hsTn) levels, higher than the 99th percentile of the laboratory, electrocardiographic and/or echocardiographic abnormalities (including pericarditis), or Magnetic Resonance
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
