A study published on Saturday that examined more than 3,000 college athletes with COVID-19 found so few cases of heart problems that future heart tests may only be used on athletes with certain symptoms.
In the study, published in the American Heart Association’s journal Circulation, researchers found signs of possible, probable, or definitive myocarditis or inflammation of the heart in 21 of 3,018 athletes (0.7%) who tested positive for COVID-19. It also found that athletes with heart problems were more likely to have moderate COVID-19 and / or cardiopulmonary symptoms.
Dr. Jonathan Drezner, director of the University of Washington’s Exercise Cardiology Medical Center and co-principal investigator on the study, said the results would help colleges and the NCAA refine heart screening protocols for athletes who test positive for COVID-19 .
“The bigger message is for the athletes who have mild or no symptoms. It is not clear that they need to have tests at all,” he said. “And I would be fine if I just did a good symptom check and made sure they feel good when they play again.”
Drezner was an advisor to the NCAA, and Dr. Brian Hainline, NCAA’s chief medical officer, served on the study group’s steering committee. The study included male and female athletes from 42 colleges and institutions in 26 sports.
The low prevalence of post-COVID-19 myocarditis in college athletes from the study and the association with moderate and cardiac symptoms is similar to the findings from a larger study of professional athletes published last month.
Dr. Aaron Baggish, director of the cardiovascular performance program at Massachusetts General Hospital in Boston, who was involved in both studies, said the college study had almost four times as many athletes, one-third of whom were women (compared to just 1.5% in the professional athlete study) and provided more detailed information on the symptoms.
Some previous small studies showed a much higher rate of post-COVID-19 myocarditis in athletes, including about 15% in a study of about two dozen Ohio state athletes. This was of concern to medical professionals and college sports administrators as they make decisions about how to return to the game.
Last year, it was common for schools to perform heart tests on all athletes who tested positive for COVID-19. A common “triad” protocol was to have an electrocardiogram, a blood test for troponin protein, and an echocardiogram – or ultrasound – of the heart. In some cases, the students also had a cardiac MRI.
Drezner said cardiac MRIs should only be used if an athlete has moderate symptoms such as “fever, body ache, lying in bed”, cardiopulmonary symptoms, an abnormality in one of the triad tests, or cardiopulmonary problems after returning to play. Using a cardiac MRI, an expensive instrument with limited availability, as the primary screening tool can lead to overdiagnosis and unnecessary restrictions on an athlete’s game, he said. “There’s potential harm,” he said.
Of the 21 cases of possible to confirmed heart problems, cardiac MRIs found 11 cases of specific or probable myocardial or myopericardial problems; Nine of these were cases where the athlete had moderate or cardiopulmonary symptoms, or had abnormal findings on any of the triad tests.
Baggish wrote in an email that schools could use the results of the study to “eliminate blanket testing for athletes with asymptomatic or mild illness, provided they recover fully and can return to exercise without problems.” [and] Limit costly and sometimes complicated cardiac tests to student athletes with moderate or greater symptom burden or symptoms upon return to exercise. “
The researchers also found that COVID-19 did not induce any athletes in the study to have a heart attack or similar event. Although one athlete suffered cardiac arrest, it has been determined that it is likely unrelated to the coronavirus, Drezner said.
“If you look around the nation, there are 8 million high school athletes with an infection rate of 10%. College probably has an infection rate of 20%. And we just don’t hear about these adverse events,” Drezner said. “That is also reassuring indirectly.”