Five out of 789 professional athletes infected with COVID-19 later had inflammatory heart disease in the largest study to date of the cardiac effects of the virus in exercise.
In data published Thursday in JAMA CardiologyDoctors affiliated with six US-based leagues tracked the 789 infected players between May and October last year.
Before returning to the game, the athletes were given three non-invasive tests that tracked their heart rhythm, performed an ultrasound of their heart, and measured a protein in their blood that may be a signal of heart damage. 30 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’s Irving Medical Center and a lead author on the paper, said the results are in line with current estimates that heart injury from COVID-19 is correlated with symptom severity. The study included infected athletes who were both symptomatic and asymptomatic. All five cases of heart disease contained symptoms that “exceeded the empirical definitions of mild COVID-19 illness”.
Doctors are still waiting for even larger datasets to be compiled by the Big Ten Sports Conference and the NCAA. Individual universities have published data from their own screenings 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 by the University of Wisconsin found only two cases out of 145 athletes.
Myocarditis is a rare but known effect of viral infections, including those that cause the common cold, H1N1 influenza, or mononucleosis. If left undiagnosed and untreated, it can lead to heart damage and sudden cardiac arrest, which can be fatal.
Concerns about this and other heart ailments sparked early debates about sports during the pandemic, particularly college football-related last summer. Engel attributed some of these concerns to confusion over how to interpret studies using cardiac MRIs to identify disease.
The professional sports leagues that contributed data to the JAMA Cardiology Paper – NBA, WNBA, NFL, NHL, Major League Baseball, and Major League Soccer – followed a standardized screening process recommended by the American College of Cardiology. It included blood tests, an electrocardiogram, and a resting echocardiogram or cardiac ultrasound. Further testing and, ultimately, diagnosis were based on abnormalities from the initial screening.
“There has been a lot of controversy about how these cardiac MRI studies should be interpreted and the real meaning of these results,” said Engel. “This study had a very clinically relevant approach. Patients who tested positive went through the recommended screening of the American College of Cardiology. Only after abnormalities emerged did we conduct further testing. Using this step-by-step approach, we found what we considered.” considered clinically relevant incidents of myocarditis and pericarditis to be fairly minor. “
Ten of the doctors involved in the study said they had received financial compensation or were employed by one of the leagues or associations involved. Engel is the consulting cardiologist for the NBA.
The five players diagnosed with heart disease who were not identified for the purposes of the study were removed from their sports every 3-6 months and are still being tested to determine the longer-term effects of the disease on their condition. Going forward, the American College of Cardiology has recommended removing screening for athletes with asymptomatic or mild cases, while maintaining screening for those with moderate or severe symptoms.
“What was comforting is that all of the athletes who passed the screening, 784 out of 789, were able to make a safe return to the game,” Engel said. “This was unknown. Early in the pandemic, when these answers were not known … we were able to show that by taking a rigorous and systematic approach to screening, we could safely return to gaming.”
In a joint statement, the six leagues said in part, “As with other lessons professional sport has learned about COVID-19, the results of this study will be widely shared to continue to contribute to growing knowledge about the virus. A commitment that we share with our players for the good of society beyond sport. “
The study results appear to be good news for athletes suffering from COVID-19, said co-author Dr. Jonathan Kim, an athletic cardiologist at Emory University in Atlanta who also works as a team cardiologist for the Atlanta Falcons.
“All four major sports are closed by 2020, all of them have ultimately returned to a season – including the athletes who entered this register – and some sports like the NBA have now been carried over to a new season,” Kim told Kaiser Health News. “These athletes are obviously still playing and they are fine.”
The study did not provide any information about what could happen in the long term to players diagnosed with heart disease. You will continue to be monitored with MRIs to see if the effects wear off over time.
“Only time will tell if we will have a failed heart epidemic in five years,” said Dr. Robert Bonow, a cardiologist at Northwestern University and editor of JAMA Cardiology, who was not involved in the study. “But I think that’s unlikely.”
The results of the other two upcoming studies on the possible COVID-heart connection are expected to be published shortly until they are peer-reviewed.
ESPN’s Paula Lavigne and Mark Schlabach and Kaiser Health News reporter Markian Hawryluk contributed to this report.