Is extensive cardiopulmonary screening useful in athletes with previous asymptomatic or mild SARS-CoV-2 infection?

Abstract

Objective: During the COVID-19 pandemic, it is essential to understand if and how to screen SARS-CoV-2-positive athletes to safely resume training and competitions. The aim of this study is to understand which investigations are useful in a screening protocol aimed at protecting health but also avoiding inappropriate examinations.

Methods: We conducted a cohort study of a professional soccer team that is based on an extensive screening protocol for resuming training during the COVID-19 pandemic. It included personal history, antigen swabs, blood tests, spirometry, resting/stress-test ECG with oxygen saturation monitoring, echocardiogram, Holter and chest CT. We also compared the findings with prior data from the same subjects before infection and with data from SARS-CoV-2-negative players.

Results: None of the players had positive swab and/or anti-SARS-CoV-2 IgM class antibodies. Out of 30 players, 18 (60%) had IgG class antibodies. None had suffered severe SARS-CoV-2-related disease, 12 (66.7%) had complained of mild COVID-19-related symptoms and 6 (33.3%) were asymptomatic. None of the players we examined revealed significant cardiovascular abnormalities after clinical recovery. A mild reduction in spirometry parameters versus pre-COVID-19 values was observed in all athletes, but it was statistically significant (p<0.05) only in SARS-CoV-2-positive athletes. One SARS-CoV-2-positive player showed increased troponin I level, but extensive investigation did not show signs of myocardial damage.

Conclusion: In this small cohort of athletes with previous asymptomatic/mild SARS-CoV-2 infection, a comprehensive screening protocol including blood tests, spirometry, resting ECG, stress-test ECG with oxygen saturation monitoring and echocardiogram did not identify relevant anomalies. While larger studies are needed, extensive cardiorespiratory and haematological screening in athletes with asymptomatic/mild SARS-CoV-2 infection appears unnecessary.

Keywords: athlete; exercise testing; heart disease; prevention; soccer.

Figure 1

Instrumental findings in a player with increased troponin I level. In the only SARS-CoV-2-positive player (asymptomatic) with increased troponin I level, resting (A) and stress-test (B) ECG were normal. Chest CT at the level of the plane passing through the upper right lobar bronchus (C) and of the plane passing through lung bases (D) was absolutely normal. (E–M) Cardiac magnetic resonance images acquired using a 1.5 T Siemens Aera (Siemens Healthcare, Erlangen, Germany). (E) Short-axis cine balanced steady-state free precession showed normal left ventricle end-diastolic volume, wall thickness and motion. (F) Short-axis T2 image showed no oedema. (G, H) Short-axis and four-chamber views showed no alteration of late gadolinium enhancement. (I, J) Short-axis T1 native and T1 postcontrast maps showed normal values of T1 and extracellular volume. (K) T2 map showed no oedema.