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. 2021 Oct 12;7(4):e001164.
doi: 10.1136/bmjsem-2021-001164. eCollection 2021.

Cardiac abnormalities in athletes after SARS-CoV-2 infection: a systematic review

Juliette C van Hattum  1 , Jessica L Spies  1 , Sjoerd M Verwijs  1 , Germaine C Verwoert  2 , R Nils Planken  3 , S Matthijs Boekholdt  1 , Maarten Groenink  1 , Arjan Malekzadeh  4 , Yigal M Pinto  1 , Arthur A M Wilde  1 , Harald T Jorstad  1
Affiliations

Cardiac abnormalities in athletes after SARS-CoV-2 infection: a systematic review

Juliette C van Hattum et al. BMJ Open Sport Exerc Med. .

Abstract

Objectives: Quantification of pericardial/myocardial involvement and risks of sudden cardiac arrest/sudden cardiac death (SCA/SCD) after SARS-CoV-2 infection in athletes who return to sports.

Design: Systematic review on post-SARS-CoV-2 infection pericardial/myocardial manifestations in athletes.

Data sources: Combinations of key terms in Medline, Embase and Scopus (through 2 June 2021).

Eligibility criteria for selecting studies: Inclusion: athletes, with cardiovascular magnetic resonance (CMR) or echocardiography after recovery from SARS-CoV-2 infection, including arrhythmia outcomes. Exclusion: study population ≥1 individual comorbidity and mean age <18 or >64 years. Quality assessment was performed using Joanna Briggs Institute Critical Appraisal tools checklists.

Results: In total, 12 manuscripts (1650 papers reviewed) comprising 3131 athletes (2198 college/student athletes, 879 professional athletes and 54 elite athletes) were included. The prevalence of myocarditis on echocardiography and/or CMR was 0%-15%, pericardial effusion 0%-58% and late gadolinium enhancement (LGE) 0%-46%. Weighted means of diagnosed myocarditis were 2.1% in college/student athletes and 0% in elite athletes. The prevalence of LGE was markedly lower in studies with high-quality assessment scores (3%-4%) versus low scores (38%-42%). A single study reported reversibility of myocardial involvement in 40.7%. No important arrhythmias were reported. Ten studies (n=4171) reporting postrecovery troponin T/I found no clear relationship with cardiac abnormalities.

Summary/conclusion: Athletes have an overall low risk of SARS-CoV-2 pericardial/myocardial involvement, arrhythmias and SCA/SCD. Rates of pericardial/myocardial abnormalities in athletes are highly variable and dependent on study quality. Troponin screenings seem unreliable to identify athletes at risk for myocardial involvement. Prospective athlete studies, with pre-SARS-CoV-2 imaging (CMR), including structured follow-up and arrhythmia monitoring, are urgently needed.

Keywords: COVID-19; athlete; cardiovascular.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA 2009 flow chart describing selection of studies included in the systematic review. CMR, cardiovascular magnetic resonance; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Total % of late gadolinium enhancement (LGE) detected on CMR stratified by risk of bias based on the quality assessment score. Each circle represents a single study. The area of the sphere represents the size of the study population. CMR, cardiovascular magnetic resonance.
Figure 3
Figure 3
Total % of pericardial effusion (PE) detected on CMR stratified by risk of bias based on the quality assessment score. Each circle represents a single study. The area of the sphere represents the size of the study population. PE, pericardial effusion.
See this image and copyright information in PMC

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