Study suggests heart screenings before COVID-19 athletes return to teams

We asked the state's top high school football players how COVID-19 has affected them. (Video by Christina Matacotta, Tyson Horne and Ryon Horne / AJC)

Ohio State researchers found some athletes recovering from COVID-19 had heart inflammation

Eleven athletes at Georgia Tech and several high school athletes in DeKalb have tested positive for COVID-19 since mid-June. A new study out of Ohio State University suggests they be tested for myocarditis before being allowed to return to their teams.

Myocarditis — inflammation of the heart muscle — “has become a major concern in the debate on whether it’s safe for college athletics to take place in the fall,” Hawks beat writer Sarah K. Spencer wrote last month.

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“Myocarditis is a significant cause of sudden cardiac death in competitive athletes and can occur with normal ventricular function,” the Ohio State researchers wrote in a paper published recently in JAMA Cardiology. “Recent studies have raised concerns of myocardial inflammation after recovery from coronavirus disease 2019 (COVID-19), even in asymptomatic or mildly symptomatic patients. Our objective was to investigate the use of cardiac magnetic resonance (CMR) imaging in competitive athletes recovered from COVID-19 to detect myocardial inflammation that would identify high-risk athletes for return to competitive play.”

“If someone has myocarditis and is actively intensely training, engaging in intense physical activity (on par with that of college athletes), that can make the inflammation worse and can potentially bring on dangerous heart rhythms, which can lead to cardiac arrest,” Spencer wrote.

“We don’t quite know the overall incidents of myocarditis in the general population, but is estimated to be relatively rare in the general population,” Dr. Jonathan Kim, chief of sports cardiology at Emory University and an assistant professor of cardiology at Emory University School of Medicine and a member of the ACC Sports and Exercise Council, told Spencer. “Now for athletes, in opposite to that, we know that myocarditis is a more sudden cause of cardiac arrest or sudden cardiac death in athletes and these data come from various registries looking at sudden death in athletes over the years. So it is certainly something that we take very seriously in athletic patients.”

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For its study, the Ohio State researchers performed cardiac magnetic resonance imaging on 26 of its athletes who tested positive for COVID-19 from June through August. None of the athletes was sick enough to be hospitalized. Twelve reported sore throats, shortness of breath or fever. The rest were asymptomatic.

The cardiac MRIs showed myocarditis in four of the athletes.

“Cardiac magnetic resonance imaging has the potential to identify a high-risk cohort for adverse outcomes and may, importantly, risk stratify athletes for safe participation because CMR mapping techniques have a high negative predictive value to rule out myocarditis,” the researchers wrote. “CMR may provide an excellent risk stratification assessment for myocarditis in athletes who have recovered from COVID-19 to guide safe competitive sports participation.”

If myocarditis is found in a patient, Emory’s Kim advocates for a conservative approach to treatment.

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“What we recommend is, at a minimum, three months of no high-end physical training,” he said. “The recommendation is rest. At a minimum three months, up to six months. And at that time, based on the clinical presentation, the athlete would undergo a series of repeat testing, which would include imaging, exercise testing, Holter monitoring to look at the heart rhythm, potentially other tests, and if all those tests are normal, then the athlete would be allowed back to return to play.”