Perspective:

This is a unique observational report of CMR findings in collegiate athletes recovered from COVID-19 infection. The high rate of LGE (42%) is similar to the 38% seen in a recent study of 93 healthy triathletes (Domenech-Ximenos B, et al., J Cardiovasc Magn Reason 2020;Sep 3:[Epub ahead of print]).

A major limitation of this study is the lack of controls, acknowledged by the authors. While the findings of LGE are concerning, and along with T2 changes are potentially suggestive of myocarditis, it is hard to conclude these are indeed high-risk findings without pre-COVID-19 CMRs (self controls) and without comparative groups such as matched healthy athletes and/or matched athletes with another type of viral infection. In addition, the Lake Louise Criteria are meant for evaluating those with suspected myocardial inflammation; however, the athletes in this study had minimal or no symptoms, normal troponin I, and normal echocardiograms. The authors acknowledged that physiologic adaptation could be responsible for the CMR findings but concluded that the four with elevated T2 signal were most likely pathologic. The wide range of quarantine times might have also affected the degree of inflammation detected. Additionally, follow-up data (e.g., repeat CMR, exercise stress testing, ambulatory ECG monitoring) are not provided.

While this study adds to emerging data, it does not imply that CMR should be performed in all COVID-19 positive patients to screen for myocardial inflammation. A large longitudinal study with proper control groups is needed to guide evolution of recommendations for resumption of sport after COVID-19 infection.