A cardiac MRI is effective at identifying inflammation of the heart muscle in athletes and can help determine when those who have recovered from COVID-19 are safely back in competitive sports, according to a new study by researchers at Ohio State University Wexner Medical can center. The research is published online in JAMA Cardiology.
Ohio State researchers examined 26 COVID-19 positive male and female athletes participating in college sports for signs of myocarditis, a rare disease that can cause heart failure and sudden cardiac death. Most cases of myocarditis, usually caused by a viral infection, occur in young adults, with men being more affected than women. Recent studies have shown myocarditis in patients who have recovered from COVID-1
Recently published protocols recommend using a combination of clinical examination, echocardiogram (ultrasound), electrocardiogram (recording of a heartbeat), and blood test to help diagnose myocarditis in athletes before resuming competitive play. Ohio State researchers used all of these methods, as well as cardiac magnetic resonance imaging (CMR), which was found to be effective at identifying myocardial inflammation that other methods missed.
“This is the first study to systematically examine the use of CMR imaging in competitive athletes who have recovered from COVID-19 infection. CMR has the potential to identify a high risk group for adverse outcomes, and especially athletes can be risk stratified for safe participation, as CMR mapping techniques have a high negative predictive value to rule out myocarditis, “said Dr. Saurabh Rajpal, a cardiologist and assistant professor in the Department of Cardiovascular Medicine at Ohio State University College of Medicine, who led the study.
In the study, myocarditis was detected in four athletes (15%) by MRI criteria. In addition to these four, eight had other signs of scar tissue, suggesting either a previous myocardial injury or normal exercise adjustment of the heart.
“It is not known what caused the scar tissue in these eight or if it is related to COVID-19,” Rajpal said. “In addition, CMR imaging ruled out myocarditis for all athletes with no MRI evidence of inflammation so they could return to exercise.”
Myocarditis can happen to anyone, not just athletes.
“The public should be aware of these findings and the symptoms of heart disease with COVID-19 infection. When people start exercising after recovering from the virus, chest pain, shortness of breath, or abnormal heartbeats should be evaluated by their doctor, ”said Dr. Curt Daniels, co-author, cardiologist, and professor at Ohio State Wexner Medical Center.
The study’s authors recommend further research on CMR screening, including long-term follow-ups with athletes and control populations.