College athletes who have recovered from COVID-19 and experienced mild symptoms are at a low risk for myocarditis, according to new research presented by Neo Poyiadji, MD, diagnostic radiology resident at Henry Ford Hospital in Michigan.
Poyiadji
Cardiovascular manifestations of COVID-19 were recognized early in the pandemic and contributed significantly to morbidity and mortality. Early cardiac magnetic resonance (CMR) studies in patients recovering from COVID-19 described a high incidence of cardiac abnormalities including a high incidence of myocarditis. This raised concerns about when athletes could return to play when recovering from COVID-19 because myocarditis is a leading cause of sudden death in athletes.
However, subsequent studies have not confirmed the suspected high prevalence of myocarditis, Dr. Poyiadji said, which was consistent with the single institution study he conducted.
Dr. Poyiadji conducted research to look at 39 Division I collegiate athletes between the ages of 18 and 23 with asymptomatic or mild COVID infection who underwent CMR between June 2020 and January 2021. Two cardiothoracic radiologists and one cardiologist independently reviewed the imaging results. No patients in the study had CMR imaging findings suggestive of myocarditis. The average ejection fraction for all patients was 57%, which is in the normal range.
Two patients in the cohort had trace pericardial effusions, but the clinical significance of that finding is unclear as neither patient developed pericarditis or other clinically significant cardiac symptoms.
Dr. Poyiadji said that while many universities instituted new screening protocols for return to play for college athletes who tested positive for COVID-19, decisionmakers should look at more recent research that finds the initial concern about higher incidence of myocarditis may have been overstated.
For example, 21% of patients had focal late gadolinium enhancement (LGE) at the right ventricle insertion point on the inferoseptal wall, which has been reported in asymptomatic high level athletes. Additionally, 18% of patients had mildly enlarged biventricular end diastolic volume indices, but that finding can also be seen in the heart of a conditioned athlete.
“Recognizing physiologic and normal variant findings on CMR in college athletes like mild chamber enlargement and focal LGE at the RV insertion point, is essential to avoid over diagnosis which has significant negative return-to-play implications for these individuals,” he said.
Dr. Poyiadji said his study was limited by its small study size and lack of a COVID-19 negative control group, but his findings suggested that CMR abnormalities in college athletes recovering from COVID-19 are very low, and screening for myocarditis in low-risk patients with no other abnormality in cardiac work up is often not indicated.
Future prospective studies are needed to accurately quantify the incidence and significance of COVID-19 related cardiovascular disease in this select patient population.
The poster presentation, “Cardiac MRI Findings in College Athletes with Recent COVID-19 Infection: Not All Doom and Gloom,” (CA02-03) will take place on Monday, Nov. 29 at 12:15 p.m. Learn more at Meeting.RSNA.org.
Short axis post gadolinium PSIR image of a 21 year-old female college athlete demonstrating non-specific focal late gadolinium enhancement at the RV insertion point on the inferior septal wall. No MR imaging features to suggest myocarditis based on updated Lake Louise criteria.
