Five of the 789 professional athletes infected with COVID-19 were found to have suffered from inflammatory heart disease in the largest study to date on the cardiac impact of the virus on sports.
In data released Thursday in JAMA Cardiology, doctors affiliated with six U.S. leagues followed the 789 infected players last year between May and October.
Before playing again, the athletes underwent three non-invasive tests that tracked their heart rhythms, performed an ultrasound of their heart, and measured a protein in their blood that may be a sign of heart damage. Thirty athletes had abnormal test results and were referred for cardiac MRI. Doctors diagnosed five cases of inflammatory heart disease (0.6% of the total), including three cases identified as myocarditis and two as pericarditis.
Dr. David Engel, a cardiologist at Columbia University’s Irving Medical Center and one of the lead authors of the paper, said the results match current assessments that COVID-19 heart injuries correlate with the severity of symptoms. The study incorporated infected athletes who were symptomatic and asymptomatic. All five cases of heart disease included symptoms that “exceeded the empirical definitions of mild disease of COVID-19,” according to the document.
Doctors still expect even larger data sets to be compiled by the Big Ten athletic conference and the NCAA. Universities have published data from their own projections with proven results. An Ohio State University study hit headlines in the fall, when researchers found that four out of 26 athletes (15%) had signs of myocarditis after COVID-19. A later study from the University of Wisconsin found only two cases of 145 athletes.
Myocarditis is a rare but well-known effect of viral infections, including those that cause the common cold, H1N1 flu, or mononucleosis. If left undiagnosed and untreated, it can cause heart damage and sudden cardiac arrest, which can be fatal.
Concern about this and other heart disease fueled initial debates about playing sports during the pandemic, especially last summer, as it was related to college football. Engel attributed some of these concerns to confusion over how to interpret studies that used cardiac MRIs to identify diseases.
The professional sports leagues that provided data in the JAMA Cardiology document (NBA, WNBA, NFL, NHL, Major League Baseball, and Major League Soccer) followed a standardized selection procedure recommended by the American College of Cardiology. It included blood tests, an electrocardiogram, and a resting echocardiogram or cardiac ultrasound. Subsequent testing and finally diagnosis were based on abnormalities from initial detection.
“There was a lot of controversy about how to interpret these cardiac MRI studies and really what the significance of these results was,” Engel said. “This study had a clinically relevant approach. Patients who tested positive went through the recommended review of the American College of Cardiology. Only after there were abnormalities did we do further testing. Using this step-by-step approach, we finding what we consider to be clinically relevant incidents of myocarditis and pericarditis is quite low. “
Ten of the doctors involved in the study revealed that they had received financial compensation or that they had been hired by one of the leagues or associations involved. Engel is the NBA’s consulting cardiologist.
The five players diagnosed with heart disease, who were not identified for the purposes of the study, were subjected to three or six months away from their sports and will continue testing to determine the long-term effects of the disease on his physical condition. condition. To move forward, the American College of Cardiology has recommended eliminating screening for athletes who had asymptomatic or mild cases while maintaining the same screening process for those with moderate or severe symptoms.
“What was reassuring was that all the athletes who went through the screening, the 784 out of 789, were able to get a safe return to the game,” Engel said. “This was unknown. At the beginning of the pandemic, when these responses were not known … we were able to demonstrate that, through a rigorous and systematic approach to screening, we were able to achieve a return to safe play.”
In a joint statement, the six leagues said in part: “As with other lessons that professional sports have learned about COVID-19, the results of this study are widely shared to continue contributing to the growing body of knowledge about the virus. a commitment that we collectively share between ourselves and our players for the benefit of society beyond sport. “
The results of the study appear to be good news for athletes suffering from COVID-19, said co-author Dr. Jonathan Kim, a sports cardiologist at Emory University in Atlanta who also works as a team cardiologist in the US. Atlanta Falcons.
“All four major sports are done in 2020, they all finally went back to one season (including the athletes who were included in that record) and some sports like the NBA have now moved to a new season,” Kim said. at Kaiser Health News. “These athletes are obviously still playing and doing well.”
The study did not shed light on what could happen in the long run with those players who were diagnosed with heart inflammation. They will continue to be monitored with MRIs to see if the effects fade over time.
“Only time will tell if in five years we will have an epidemic of failed hearts,” said Dr. Robert Bonow, a cardiologist at Northwestern University and editor of JAMA Cardiology, who was not affiliated with the study. “But I think it’s unlikely.”
The results of the next two studies on the possible COVID-cardiac link are expected to be published soon, pending peer review.
ESPN’s Paula Lavigne and Mark Schlabach and Kaiser Health News journalist Markian Hawryluk contributed to this report.