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ORCCA – SARS-CoV-2 Cardiac Involvement in Competitive Athletes

May 18, 2021

Written by Vivian Lei

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In this large registry study, SARS-CoV-2 infection in young competitive athletes carries a low prevalence of cardiac involvement (0.5-3%) and low risk of clinical events in short-term follow-up.

Why does this matter?
We covered the cardiac effects of COVID-19 on a small cohort of elite athletes previously. In this larger cohort of young, healthy athletes who contract COVID-19, what are the clinical implications of acute infection on risk for cardiac involvement and return-to-play?

The ORCCA registry
This was a prospective observational registry study with a cohort of 19,378 athletes enrolled from 42 colleges and universities. Of these, 3,018 (15.6%) tested positive for SARS-CoV-2 infection and met study inclusion criteria. Most were asymptomatic (33%) or had mild symptoms (29%), such as loss of taste or smell, headache, or sore throat. Cardiopulmonary symptoms were reported by 13% of athletes. Abnormalities were detected on cardiac triad testing with echocardiography (24/2556, 0.9%), 12-lead ECG (21/2999, 0.7%), and cardiac troponin (24/2719, 0.9%). Cardiac involvement on cardiac magnetic resonance (CMR) scans was found in 3.0% of athletes who underwent CMR as a primary screening method and 0.5% of athletes who had cardiac triad testing. When CMR was clinically indicated due to symptom burden or for abnormal triad test results, its diagnostic yield was four-fold higher at 12.6%. Cardiopulmonary symptoms (OR 3.1) and any abnormal triad test (OR 37.4) were independently predictive of cardiac involvement. Median follow-up was 113 days during which time only one adverse cardiac event occurred which was determined to be unrelated to SARS-CoV-2 infection.

Based on this data, researchers recommend considering cardiac triad testing in athletes with SARS-CoV-2 infection who experience moderate cardiopulmonary symptoms during initial illness or return to exercise. CMR is most useful in athletes with cardiopulmonary symptoms and/or abnormal triad testing. Athletes with asymptomatic or mild symptom burden from SARS-CoV-2 infection do not require additional cardiac testing prior to return-to-play.

SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes. Circulation. 2021 Apr 17. doi: 10.1161/CIRCULATIONAHA.121.054824. Online ahead of print.

What are your thoughts?