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Meta-Analysis
. 2022 Apr 2;19(7):4279.
doi: 10.3390/ijerph19074279.

Myocarditis in Athletes Recovering from COVID-19: A Systematic Review and Meta-Analysis

Gloria Modica  1 , Massimiliano Bianco  1 , Fabrizio Sollazzo  1 , Emanuela Di Murro  1 , Riccardo Monti  1 , Michela Cammarano  1 , Lorenzo Morra  1 , Francesco Maria Nifosì  1 , Salvatore Francesco Gervasi  1 , Ester Manes Gravina  2 , Paolo Zeppilli  1 , Vincenzo Palmieri  1
Affiliations
Meta-Analysis

Myocarditis in Athletes Recovering from COVID-19: A Systematic Review and Meta-Analysis

Gloria Modica et al. Int J Environ Res Public Health. .

Abstract

Background: To assess the event rates of myocarditis detected by Cardiac Magnetic Resonance (CMR) in athletes who recovered from COVID-19.

Methods: A systematic literature search was performed to identify studies reporting abnormal CMR findings in athletes who recovered from COVID-19. Secondary analyses were performed considering increased serum high sensitivity troponin (hs-Tn) levels and electrocardiographic (ECG) and echocardiographic (ECHO) abnormalities.

Results: In total, 7988 athletes from 15 studies were included in the analysis. The pooled event rate of myocarditis was 1% (CI 1-2%), reaching 4% in the sub-group analysis. In addition, heterogeneity was observed (I2 43.8%). The pooled event rates of elevated serum hs-Tn levels, abnormal ECG and ECHO findings were 2% (CI 1-5%), 3% (CI 1-10%) and 2% (CI 1-6%), respectively. ECG, ECHO and serum hs-Tn level abnormalities did not show any correlation with myocarditis.

Conclusions: The prevalence of COVID-19-related myocarditis in the athletic population ranges from 1 to 4%. Even if the event rate is quite low, current screening protocols are helpful tools for a safe return to play to properly address CMR studies.

Trial registration: the study protocol was registered in the PROSPERO database (registration number: CRD42022300819).

Keywords: COVID-19; athletes; cardiac magnetic resonance; myocarditis; physical activity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA’s flow diagram.
Figure 2
Figure 2
Forest plot: horizontal axis represents 95% confidence interval; rhombuses and squares represent the weight of the study in relation to the total. (A) Forest plot showing myocarditis event rate in the total sample of athletes (n = 7988) who recovered from COVID-19 infection. (B) Forest plot showing myocarditis event rate only in the subgroup of athletes (n = 2390) who were studied with CMR. (C) Forest plot showing myocarditis rate in studies in which all athletes who recovered from COVID-19 were studied with CMR. This subgroup included 389 athletes.
See this image and copyright information in PMC

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