Using cardiac magnetic resonance (CMR) imaging to screen competitive collegiate athletes with COVID-19 may increase detection of clinical and subclinical myocarditis, according to a study published May 27 in JAMA Cardiology.

Curt J. Daniels, MD, FACC, et al., sought to determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies to safe return to play. Researchers surveyed the Big Ten COVID-19 Registry principal investigators for observational data from March 1 to Dec. 15, 2020.

Results showed that of the 1,597 athletes from 13 universities who received cardiovascular testing, 37 athletes (2.3%) were diagnosed with COVID-19 myocarditis. Nine of these athletes had clinical myocarditis and 27 had subclinical myocarditis. Researchers found that myocarditis would have been detected in only five athletes (0.31%) if cardiac testing was based on cardiac symptoms alone. CMR imaging for all athletes led to a 7.4-fold increase in detection of myocarditis.

"At present, we do not know the natural history of the short- and long-term implications to an athlete with COVID-19 clinical or subclinical myocarditis," write the authors of the study. "To address these concerns, we must find ways to minimize the variability in performance among academic centers to diagnose myocarditis, perhaps through standardized evidence-based diagnostic algorithms and testing protocols, and when indicated, standardization of CMR protocols and interpretation."

In a related editorial comment, James E. Udelson, MD, FACC; Ethan J. Rowin, MD; and Barry J. Maron, MD, MACC, explain, "Although we often call for more data, we are likely at a point now in which more data might get us closer to the true incidence of signs on CMR imaging of myocarditis with narrower confidence intervals for athletes in the aftermath of COVID-19, but we will still face the same conceptual hurdles of pretest probability of the individuals tested and sensitivity and specificity of the testing modalities, and the practical will always need to be balanced against the perfect."

"I am proud to see the ACC Sports Cardiology Section taking the lead in advising the NCAA, athletic conferences, and schools on how to best evaluate athletes after COVID-19 infection and keep them safe," says Richard J. Kovacs, MD, MACC, past president of the ACC. "The Big Ten data will be important for their recommendations going forward."

ACC's Care of the Athletic Heart Virtual: From Elite to Exercise Enthusiasts, will take place virtually June 24 – 26 and feature sessions on COVID-19, including the keynote session, "Coronavirus-2019: Current Perspectives from the Lockdown to the Present," three cases on COVID-19 and the athletic heart, and more. Sessions will be available on demand through Sept. 24. Register today!

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology

Keywords: Myocarditis, Incidence, Prevalence, Confidence Intervals, COVID-19, Athletes, Sports, Cardiovascular System, Magnetic Resonance Spectroscopy, Probability, Cardiology, Registries, Reference Standards, Algorithms, SARS-CoV-2

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