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. 2022 Feb:14:100125.
doi: 10.1016/j.ahjo.2022.100125. Epub 2022 Mar 31.

Utility of exercise testing to assess athletes for post COVID-19 myocarditis

R D Mitrani  1 , J Alfadhli  1 , M H Lowery  1 , T M Best  2 , J M Hare  1   3 , J Fishman  4 , C Dong  5 , Y Siegel  4 , V Scavo  6 , G J Basham  7 , R J Myerburg  1 , J J Goldberger  1
Affiliations

Utility of exercise testing to assess athletes for post COVID-19 myocarditis

R D Mitrani et al. Am Heart J Plus. 2022 Feb.

Abstract

Purpose: This study assessed a functional protocol to identify myocarditis or myocardial involvement in competitive athletes following SARS-CoV2 infection.

Methods: We prospectively evaluated competitive athletes (n = 174) for myocarditis or myocardial involvement using the Multidisciplinary Inquiry of Athletes in Miami (MIAMI) protocol, a median of 18.5 (IQR 16-25) days following diagnosis of COVID-19 infection. The protocol included biomarker analysis, ECG, cardiopulmonary stress echocardiography testing with global longitudinal strain (GLS), and targeted cardiac MRI for athletes with abnormal findings. Patients were followed for median of 148 days.

Results: We evaluated 52 females and 122 males, with median age 21 (IQR: 19, 22) years. Five (2.9%) had evidence of myocardial involvement, including definite or probable myocarditis (n = 2). Three of the 5 athletes with myocarditis or myocardial involvement had clinically significant abnormalities during stress testing including ventricular ectopy, wall motion abnormalities and/or elevated VE/VCO2, while the other two athletes had resting ECG abnormalities. VO2max, left ventricular ejection fraction and GLS were similar between those with or without myocardial involvement. No adverse events were reported in the 169 athletes cleared to exercise at a median follow-up of 148 (IQR108,211) days. Patients who were initially restricted from exercise had no adverse sequelae and were cleared to resume training between 3 and 12 months post diagnosis.

Conclusions: Screening protocols that include exercise testing may enhance the sensitivity of detecting COVID-19 related myocardial involvement following recovery from SARS-CoV2 infection.

Keywords: CPET, cardiopulmonary exercise test; Cardiac MRI; Cardiac injury; Covid-19; ECG, electrocardiogram; ECHO, echocardiogram; EF, ejection fraction; GLS, global longitudinal strain; LGE, late gadolinium enhancement; LV, left ventricular; MIAMI, Multidisciplinary Inquiry of Athletes in Miami In COVID-19 recovery; MRI, magnetic resonance imaging; Myocarditis; Ventricular arrhythmia.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The University of Miami is an equity owner in Longeveron Inc., which has licensed intellectual property from the University of Miami.

Figures

Fig. 1
Fig. 1
This figure demonstrates the results of the MIAMI protocol in 147 consecutive competitive athletes.
Fig. 2
Fig. 2
Presence of multiform ventricular ectopy in one athlete during her stress testing. Cardiac MRI showed abnormal T1 (septum) and abnormal T2 (lateral wall-46 msec), small pericardial effusion and small focus of LGE - inferolateral wall.
Fig. 3
Fig. 3
A) Abnormal cardiac in the 4-chamber view demonstrates curvilinear pericardial delayed enhancement along the lateral wall of the left ventricle. B) Short axis postcontrast image demonstrates focal irregular enhancement of the epicardial surface of the lateral left ventricular wall (arrow).
See this image and copyright information in PMC

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