Cardiac Function and Structure before and after Mild SARS-CoV-2 Infection in Elite Athletes Using Biventricular and Left Atrial Strain

Abstract

Background/objectives: Myocardial involvement has been observed in athletes following SARS-CoV-2 infection. It is unclear if these changes are due to myocardial damage per se or to an interruption in training. The aim of this study was to assess cardiac function and structure in elite athletes before and after infection (INFAt) and compare them to a group of healthy controls (CON).

Methods: Transthoracic echocardiography was performed in 32 elite athletes, including 16 INFAt (median 21.0 (19.3-21.5) years, 10 male) before (t₀) and 52 days after (t₁) mild SARS-CoV-2 infection and 16 sex-, age- and sports type-matched CON. Left and right ventricular global longitudinal strain (LV/RV GLS), RV free wall longitudinal strain (RV FWS) and left atrial strain (LAS) were assessed by an investigator blinded to patient history.

Results: INFAt showed no significant changes in echocardiographic parameters between t₀ and t₁, including LV GLS (-21.8% vs. -21.7%, p = 0.649) and RV GLS (-29.1% vs. -28.7%, p = 0.626). A significant increase was observed in LA reservoir strain (LASr) (35.7% vs. 47.8%, p = 0.012). Compared to CON, INFAt at t₁ had significantly higher RV FWS (-33.0% vs. -28.2%, p = 0.011), LASr (47.8% vs. 30.5%, p < 0.001) and LA contraction strain (-12.8% vs. -4.9%, p = 0.050) values.

Conclusions: In elite athletes, mild SARS-CoV-2 infection does not significantly impact LV function when compared to their pre-SARS-CoV-2 status and to healthy controls. However, subtle changes in RV and LA strain may indicate temporary or training-related adaptions. Further research is needed, particularly focusing on athletes with more severe infections or prolonged symptoms.

Keywords: COVID-19; elite athletes; myocardial inflammation; speckle tracking echocardiography; sports cardiology.

Figure 1

Differences in left and right ventricular strain, circumferential strain and left atrial strain between pre- and post-SARS-CoV-2 infection in athletes (INFAt) and in healthy controls (CON). (A): Left ventricular global longitudinal strain (LV GLS) in %; (B): Global circumferential strain basal (GCS basal) in %; (C): Global circumferential strain midventricular (GCS mid) in %; (D): Right ventricular free wall longitudinal strain (RV FWS) in %; (E): Right ventricular global longitudinal strain (RV GLS) in %; (F): Left atrial reservoir strain (LASr) in %; (G): Left atrial conduit strain (LAScd) in %; (H): Left atrial contraction strain (LASct) in %. Significant results are presented as follows: * < 0.05; *** < 0.001.