Five of 789 professional athletes infected with COVID-19 were later found to have suffered from inflammatory heart disease in the largest study to date on the cardiac impact of the virus in sports.
In data published Thursday in JAMA Cardiology, doctors affiliated with six US-based leagues followed the 789 players infected last year between May and October.
Before playing again, the athletes underwent three non-invasive tests that tracked heart rhythms, took an ultrasound of their hearts, 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 a 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 Irving Medical Center and a lead author on the paper, said the results were in line with current assessments that COVID-19 cardiac injury correlates with severity. symptoms. The study incorporated infected athletes who were both symptomatic and asymptomatic. All five cases of heart disease included symptoms that “exceeded the empirical definitions of mild COVID-19 illness,” according to the document.
Doctors are still waiting for the Big Ten athletic conference and the NCAA to compile even larger data sets. Individual universities have published data from their own assessments with mixed results. An Ohio State University study made headlines in the fall, when researchers found that four out of 26 athletes, or 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 known effect of viral infections, including those that cause the common cold, H1N1 flu, or mononucleosis. Left undiagnosed and untreated, it can cause heart damage and sudden cardiac arrest, which can be fatal.
Concern about it and other heart ailments fueled initial debates about playing sports during the pandemic, especially last summer when it came to college football. Engel attributed some of those concerns to confusion about how to interpret studies that used cardiac MRIs to identify disease.
The professional sports leagues that contributed data to the JAMA cardiology article (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 EKG, and a resting echocardiogram or cardiac ultrasound. Additional tests, and eventually diagnosis, were based on initial detection abnormalities.
“There was a lot of controversy about how to interpret these cardiac MRI studies and what the meaning of these findings really was,” Engel said. “This study had a very clinically relevant approach. Patients who tested positive underwent the screening test recommended by the American College of Cardiology. It was only after there were abnormalities that we went on to do more. Evidence. With this tiered approach, we found 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 were employees of one of the leagues or associations involved. Engel is the NBA’s consulting cardiologist.
The five players diagnosed with heart conditions, which were not identified for the purposes of the study, were subjected to between three and six months away from their sports and will continue to be evaluated to determine the long-term effects of the disease on their physical condition. condition. Going forward, the American College of Cardiology has recommended eliminating screening for athletes who had mild or asymptomatic cases, while maintaining the same screening process for those who had moderate or severe symptoms.
“What was reassuring is that all the athletes who went through the evaluation, 784 of 789, were able to achieve a safe return to the game,” Engel said. “This was unknown. At the beginning of the pandemic, when these responses were unknown … we were able to show that by going through a rigorous and systematic approach to detection, we were able to achieve a safe return to the game.”
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 being widely shared to continue to contribute to the growing body of knowledge about the virus. . a commitment that we collectively share among ourselves and with our players for the benefit of society beyond sport. “
The study results 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 cardiologist for the Atlanta Falcons team.
“The four main sports are done in 2020, they all finally returned to one season, including the athletes that were included in this record, and some sports like the NBA have now moved into a new season,” Kim told Kaiser. Health News. “Those athletes are obviously still playing and doing well.”
The study did not shed light on what might happen in the long term with players diagnosed with heart inflammation. They will continue to be monitored with MRIs to see if the effects wear off over time.
“Only time will tell if, five years from now, 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 that’s unlikely.”
The results of the other two future studies on the possible cardiac-COVID link are expected to be published soon, pending peer review.
ESPN’s Paula Lavigne and Mark Schlabach and Kaiser Health News reporter Markian Hawryluk contributed to this report.