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Observational Study
. 2023 Nov 27;109(24):1851-1857.
doi: 10.1136/heartjnl-2023-322645.

Non-COVID-19 cardiovascular pathology from return-to-play screening in college athletes after COVID-19

Christian F Klein  1 , Bradley J Petek  2 , Nathaniel Moulson  3 , Aaron L Baggish  4 , Timothy W Churchill  5 , Kimberly G Harmon  6 , Stephanie A Kliethermes  7 , Manesh R Patel  8 , Jonathan A Drezner  9
Affiliations
Observational Study

Non-COVID-19 cardiovascular pathology from return-to-play screening in college athletes after COVID-19

Christian F Klein et al. Heart. .

Abstract

Objective: Concerns for cardiac involvement after SARS-CoV-2 infection led to widespread cardiac testing in athletes. We examined incidental non-COVID-19 cardiovascular pathology in college athletes undergoing postinfection return-to-play screening.

Methods: The Outcomes Registry for Cardiac Conditions in Athletes was a nationwide prospective multicentre observational cohort study that captured testing and outcomes data from 45 institutions (September 2020-June 2021). Athletes with an ECG and transthoracic echocardiogram (TTE) and no pre-existing conditions were included. Findings were defined as major (associated with sudden cardiac death or requiring intervention), minor (warrants surveillance), incidental (no follow-up needed) or uncertain significance (abnormal with subsequent normal testing).

Results: Athletes with both ECG and TTE (n=2900, mean age 20±1, 32% female, 27% black) were included. 35 (1.2%) had ECG abnormalities. Of these, 2 (5.7%) had TTE abnormalities indicating cardiomyopathy (hypertrophic-1, dilated-1), and 1 with normal TTE had atrial fibrillation. Of 2865 (98.8%) athletes with a normal ECG, 54 (1.9%) had TTE abnormalities: 3 (5.6%) with aortic root dilatation ≥40 mm, 15 (27.8%) with minor abnormalities, 25 (46.3%) with incidental findings and 11 (20.4%) with findings of uncertain significance. Overall, 6 (0.2%) athletes had major conditions; however, coronary anatomy and aortic dimensions were inconsistently reported and pathology may have been missed.

Conclusion: Major non-COVID-19 cardiovascular pathology was identified in 1/500 college athletes undergoing return-to-play screening. In athletes without ECG abnormalities, TTE's added value was limited to pathological aortic root dilatation in 1/1000 athletes and minor abnormalities warranting surveillance in 1/160 athletes. Two-thirds of findings were incidental or of uncertain significance.

Keywords: COVID-19; aortic aneurysm; cardiomyopathies; echocardiography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Classification of echocardiographic findings by severity. SCA/D, sudden cardiac arrest or death; TTE, transthoracic echocardiogram.
Figure 2
Figure 2
Study design and selection of athlete cohort. ORCCA, Outcomes Registry for Cardiac Conditions in Athletes; TTE, transthoracic echocardiogram.
Figure 3
Figure 3
Summary of structural and non-structural findings in patients undergoing ECG and TTE screening. ASA, atrial septal aneurysm; ASD, atrial septal defect; BAV, bicuspid aortic valve; DCM, dilated cardiomyopathy; GLS, global longitudinal strain; HCM, hypertrophic cardiomyopathy; LV, left ventricle; LVH, left ventricular hypertrophy; LVNC, left ventricular non-compaction; MV, mitral valve; MVP, mitral valve prolapse; PFO, patent foramen ovale; RV, right ventricle; TTE, transthoracic echocardiogram; WMA, wall motion abnormalities. *Some athletes had more than one minor or incidental finding.
See this image and copyright information in PMC

References

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