COVID-19 Associated With Asymptomatic Myocarditis in College Athletes

The long-term implications of post-COVID-19 myocardial injury detected by cardiac MRI are still unknown.

A small but significant percentage of college athletes with COVID-19 develop asymptomatic myocarditis only visible on cardiac MRI, according to a study presented at the annual meeting of the Radiological Society of North America. The condition has been linked to up to 20% of sudden deaths in young athletes, and it can leave behind heart muscle scarring that can result in lasting damage.

The investigators reviewed the results of 1597 cardiac MRI exams collected at 13 participating schools. All COVID-positive athletes from these institutions underwent a complete cardiac battery of tests, including cardiac MRI, echocardiogram, ECG, and blood tests, as well as a complete medical history.

According to the study results, 2.3% of participants were diagnosed with COVID-19 myocarditis. Although this rate is similar to the incidence of myocarditis in the general population, 54% of athletes diagnosed with myocarditis had no clinical symptoms or cardiac testing abnormalities and could only be diagnosed via cardiac MRI.

“Testing patients for clinical symptoms of myocarditis only captured a small percentage of all patients who had myocardial inflammation,” said Jean Jeudy, MD, professor and radiologist at the University of Maryland School of Medicine in Baltimore, in a press release. “Cardiac MRI for all athletes yielded a 7.4-fold increase in detection.”

According to the investigators, the long-term implications of post-COVID-19 myocardial injury detected by cardiac MRI are still unknown. The Big Ten Cardiac Registry will allow researchers to look beyond the presence of abnormalities and study areas such as changes in exercise function over time.

“We still don’t know the long-term effects,” Jeudy said. “Some athletes had issues that resolved within a month, but we also have athletes with continued abnormalities on their MRI as a result of their initial injury and scarring. There are a lot of chronic issues with COVID-19 that we need to know more about, and hopefully this registry can be one of the major parts of getting that information.”

There are significant obstacles to widespread use of cardiac MRI in college athletes, including high costs and a lack of access to advanced MRI capability, according to the researchers. However, they added that this study demonstrates the importance of cardiac MRI as a diagnostic tool.

“The role of cardiac MRI as a screening tool in this population needs to be explored,” Jeudy said. “The reality is that there are a small percentage of cases where we know the athletes have an increased risk for sudden death, and using cardiac MRI will increase the number of players who are identified.”

REFERENCE

COVID-19 linked to heart inflammation in college athletes [news release]. EurekAlert; November 29, 2021. Accessed November 30, 2021. https://www.eurekalert.org/news-releases/935767