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COVID-19 Silent Myocarditis – COMPETE CMR

March 15, 2021

Written by Clay Smith

Spoon Feed
The prevalence of silent myocarditis among collegiate athletes, detected only on cardiac magnetic resonance imaging (CMR), was 3%.

Why does this matter?
We know COVID-19 may cause myocarditis in some patients. But what about patients with mild symptoms or no symptoms of COVID-19 infection? And what about athletes? Is it safe for them to return to competitive play after a mild bout of COVID-19? Could they still have myocarditis with no symptoms of dyspnea and a normal ECG, troponin i, and echocardiogram?

This was a study comparing the CMR findings of 59 collegiate athletes, all of whom had mild or asymptomatic COVID-19, to 60 control athletes (prior to COVID-19) and 27 healthy controls. CMR was performed a median of 21.5 days from COVID-19 symptom onset in the 59 cases. They found 2 (3%) asymptomatic athletes with CMR evidence of myocarditis. Both had normal ECG, troponin i, and echo. One of these athletes developed progressive dyspnea and a drop in EF on echo. One athlete had pericarditis only detected on CMR. The prevalence of myocarditis among mildly symptomatic or asymptomatic athletes was low, and the clinical relevance of myocarditis on CMR that is not detected with ECG, biomarkers, or echo is unknown. This study shows silent myocarditis is uncommon but possible and may have subsequent clinical impact in some patients.

Another Spoonful
See this helpful JAMA article on return to play for athletes with COVID-19.

COVID-19 Myocardial Pathology Evaluation in Athletes With Cardiac Magnetic Resonance (COMPETE CMR). Circulation. 2021 Feb 9;143(6):609-612. doi: 10.1161/CIRCULATIONAHA.120.052573. Epub 2020 Dec 17.

What are your thoughts?