Post-COVID Cardiac Involvement Rare in College Athletes

Debra L. Beck

April 23, 2021

Young athletes are unlikely to experience ongoing heart problems post–COVID-19 infection.

In a multicenter study conducted during September-December 2020, only 0.7% of 3,018 collegiate athletes who tested positive for SARS-CoV-2 infection were found to have definite, probable, or possible infection-related cardiac involvement.

None experienced an adverse cardiac event and only five (0.2%) required hospitalization for noncardiac complications of COVID-19.

"The take-home message is that cardiac involvement does not happen as much as we had initially feared. It's in the range of 0.5% to 3%, depending on how you define cardiac involvement, which is not nothing, but it's not the 30% or 50% that some early studies hinted at," said Kimberly G. Harmon, MD, of the University of Washington, Seattle.

Harmon, along with Jeffrey A. Drezner, MD, also from UW, and Aaron L. Baggish, MD, of Massachusetts General Hospital, Boston, were co–primary investigators of the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study. The group's findings were published April 17 in Circulation.

Nearly 20,000 Athletes Tested

The researchers prospectively tested 19,378 athletes for SARS-CoV-2 infection from 42 U.S. colleges and universities during the study period. A total of 3,018 (16%; mean age, 20 years; 32% female) tested positive and underwent cardiac evaluation.

"We didn't prescribe what the schools had to do in terms of cardiac evaluation, but most of these colleges are well resourced, and about 74% of athletes were evaluated using the triad testing strategy of 12-lead electrocardiography, cardiac troponin, and transthoracic echocardiography [TEE], with cardiac magnetic resonance [CMR ]when indicated," explained Harmon. Only 198 athletes underwent primary screening with CMR.

Athletes were often tested multiple times for SARS-CoV-2 infection by participating institutions and were included in this study if they had any positive test and underwent postinfection cardiac screening.

The cohort includes athletes representing 26 distinct sporting disciplines, including American-style football (36%), basketball (9%), and cross country/track and field (8%). Most were asymptomatic or had only mild COVID-19 symptoms (33% and 29%, respectively).

"Exercise Appears to Be Protective"

Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG in 0.7% of athletes (21 of 2,999), cardiac troponin elevation in 0.9% (24/2,719), and abnormal TTE findings in 0.9% (24/2,556).

The odds of having cardiac involvement was 3.1 times higher in athletes with cardiopulmonary symptoms.

"One thing we've seen in the literature and in this cohort, is that exercise appears to be protective to some extent from COVID-19. We had a lot of cases, but in the whole cohort, only five athletes were hospitalized with COVID and those were for noncardiac reasons," said Harmon.

During a median clinical surveillance of 113 days, there was one (0.03%) adverse cardiac event likely unrelated to SARS-CoV-2 infection.

The diagnostic yield for probable or definite cardiac involvement was 6.7 times higher for a CMR obtained for clinical reasons (10.1%) versus a primary screening CMR (1.5%).

"This is data we desperately needed. Small, single-center studies early in the pandemic had indicated a higher prevalence of cardiac involvement, which led us to be very conservative about return-to-play in the early days," said Jeffrey Lander, MD, who was not involved in the study.

The study is complementary, he noted, to one published in March that looked at professional athletes post–COVID-19 and also found cardiac pathology in fewer than 1%. The mean age in that study was 25 years.

"They saw a similarly low rate of cardiac involvement in professional athletes, and together with this study, it gives us new information that is also reassuring," added Lander, codirector of sports cardiology at Saint Barnabas Medical Center in Livingston, N.J., an RWJBarnabas Health facility, and team cardiologist for Seton Hall University in South Orange, N.J.

Limit CMR to Symptomatic Athletes

"I think this data can be extended beyond the college athlete. And it's fair to say to high school athletes and young recreational athletes who have had asymptomatic or mild infection, you probably don't need further workup if you're feeling fine," suggested Harmon.

"For those with moderate or severe illness, then the triple screen protocol is a good idea, particularly if they are having any symptoms," she added.

Lander agrees that athletes should be screened by appropriate providers before returning to sports, but that CMR should not be used routinely for return-to-play screening.

"We've never taken a group of, say, 1,000 college athletes who just recovered from the flu and done cardiac MRIs on them, so it's a bit like opening Pandora's box when it's used too liberally. It's difficult to assess if the findings are secondary to COVID infection or from something entirely unrelated," he noted.

ORCCA is a collaboration of the American Heart Association and the American Medical Society for Sports Medicine to track COVID-19 cases among National Collegiate Athletic Association (NCAA) athletes. The current study was supported by a grant from the American Medical Society for Sports Medicine.

This article originally appeared on, part of the Medscape Professional Network.


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