Abstract Background Possible mild myocardial involvement has been observed in the form of reduced left ventricular global longitudinal strain (LV GLS) in athletes after SARS-CoV-2 infection compared to healthy athletes. It is not yet clear whether these minor changes are caused by SARS-CoV-2 or are possibly due to detraining. Purpose This study investigates whether there are potential changes in LV and right ventricular (RV) GLS and global circular strain (GCS) in elite athletes (INFAt) before and after SARS-CoV-2 infection and whether there are differences in cardiac function between post-infection INFAt and healthy control athletes (CON). Methods In this single-center substudy, transthoracic echocardiography was performed in 32 elite athletes participating in endurance, strength and mixed sports. 16 INFAt (22.63±5.34 years, 10 male) were examined before (t0) and at a median of 52 days after (t1) SARS-CoV-2 infection and matched by gender, age and sport with healthy controls (CON). LV GLS and GCS were determined in four-, two-, and three-chamber views and RV free wall longitudinal strain/global longitudinal strain (RV FWSL/RV GLS) in RV focused four-chamber apical view. Left atrial strain was determined in form of left atrial reservoir strain (LASr), left atrial conduit strain (LAScd) and left atrial contraction strain (LASct) in the apical four-chamber view. Strain values were assessed offline by a blinded investigator. Results There was no change in LV GLS (t0 -21.8 vs. t1 -21.7, p=0.649), GCS basal (t0 -32.9 vs. t1 -26.6, p=0.403), GCS midventricular (t0 -23.7 vs. t1 -29.9, p=0.589) and RV FWSL (t0 -31.9 vs. t1 -33.0, p=0.326) or RV GLS (t0 -29.1 vs. t1 -28.7, p=0.626) in INFAt from from pre to post-SARS-CoV-2 infection. Overall LV GLS (-21.7 vs. -22.7, p=0.318), GCS basal (-26.6 vs. -25.8, p=0.409) and GCS mid-ventricular (-29.9 vs. -29.0, p=0.788) and routine echocardiography parameters were not different between INFAt and CON. Only left atrial parameters were significantly different with high normal values in INFAt for LASr (INFAt 47.8 (40.5 – 51.8) vs. CON 30.5 (27.7 – 32.9), p < 0.001) and LASct (INFAt -12.8 (-17.9 – -6.7) vs. CON -4.9 (-14.25 – -1.8), p = 0.050). Conclusions We did not detect cardiac involvement in the form of a significant reduction of left or right ventricular strain within INFAt before and after SARS-CoV-2 infection nor between INFAt and CON. Cardiac function does not appear to be impaired in athletes with mild infection. Studies on left and right ventricular changes in athletes or in the general population with moderate and severe disease courses are required, as are studies on other viral infections, to issue a specific recommendation on return-to-play after viral infections.
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