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Pericardial Involvement in College Athletes Recovering From COVID-19
Quick Takes
- More than one-half of the patients who recovered from uncomplicated COVID-19 had abnormal echo and/or CMR findings with pericardial late enhancement with pockets of pericardial effusion and patchy or a diffuse pattern of myocardial segmental strain abnormalities.
- Mild or asymptomatic COVID-19 is not a benign illness, with more than one-half of the younger individuals having subclinical myocardial and pericardial disease.
- Additional studies are indicated to address the underlying pathophysiological process and long-term effects of the myopericardial abnormalities seen in uncomplicated COVID-19.
Study Questions:
What is the spectrum of cardiac abnormalities in student athletes with uncomplicated coronavirus disease 2019 (COVID-19)?
Methods:
The investigators performed screening echocardiograms in 54 consecutive student athletes (mean age, 19 years; 85% male) who had positive results of reverse transcription polymerase chain reaction nasal swab testing of the upper respiratory tract or immunoglobulin G antibodies against severe acute respiratory syndrome coronavirus type 2. Sequential cardiac magnetic resonance imaging (CMR) was performed in 48 (89%) subjects. Comparisons of continuous variables of demographics, echocardiography, and CMR among different groups (i.e., control subjects, symptomatic COVID-19–positive student athletes, and asymptomatic COVID-19–positive student athletes) were performed using either the Kruskal-Wallis test with Dunn-Bonferroni correction or the Mann-Whitney U test.
Results:
A total of 16 (30%) athletes were asymptomatic, whereas 36 (66%) and two (4%) athletes reported mild and moderate COVID-19–related symptoms, respectively. For the 48 athletes completing both imaging studies, abnormal findings were identified in 27 (56.3%) individuals. This included 19 (39.5%) athletes with pericardial late enhancements with associated pericardial effusion. Of the individuals with pericardial enhancements, six (12.5%) had reduced global longitudinal strain and/or an increased native T1. One patient showed myocardial enhancement and reduced left ventricular ejection fraction or reduced global longitudinal strain with or without increased native T1 values was also identified in an additional seven (14.6%) individuals. Native T2 findings were normal in all subjects, and no specific imaging features of myocardial inflammation were identified. Hierarchical clustering of left ventricular regional strain identified three unique myopericardial phenotypes that showed significant association with the CMR findings (p = 0.03).
Conclusions:
The authors concluded that more than one in three previously healthy college athletes recovering from COVID-19 infection showed imaging features of a resolving pericardial inflammation.
Perspective:
This echocardiography study with speckle tracking strain and CMR assessed cardiac involvement in college student athletes who recovered from uncomplicated COVID-19 and reports abnormal findings in more than one-half of the patients, with 39.5% having pericardial late enhancement with pockets of pericardial effusion and patchy or a diffuse pattern of myocardial segmental strain abnormalities. This study suggests that mild or asymptomatic COVID-19 is not a benign illness, with more than one-half of the younger individuals showing subclinical myocardial and pericardial disease. Additional studies are indicated to address the underlying pathophysiological process and long-term effects of the myopericardial abnormalities seen in uncomplicated COVID-19.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Pericardial Disease, Prevention, Sports and Exercise Cardiology, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Prevention, Acute Heart Failure, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology, Sports and Exercise and Imaging
Keywords: Athletes, Coronavirus, COVID-19, Diagnostic Imaging, Echocardiography, Heart Failure, Inflammation, Magnetic Resonance Imaging, Myocarditis, Myocardium, Pericardial Effusion, Primary Prevention, severe acute respiratory syndrome coronavirus 2, Students, Ventricular Function, Left, Young Adult
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