As athletes recover from Covid-19, taking images of their hearts to screen for inflammation may help doctors determine when it could be safe to get back in the game, new research suggests.

The small study — conducted by researchers at Ohio State University — found in cardiac magnetic resonance images, or MRIs, that among 26 of the university’s competitive athletes who were recovering from Covid-19, four showed signs of inflammation of the heart muscle, called myocarditis.

“Our objective was to investigate the use of cardiac magnetic resonance (CMR) imaging in competitive athletes recovered from COVID-19 to detect myocardial inflammation that would identify high-risk athletes for return to competitive play,” the researchers wrote in a research letter published in the journal JAMA Cardiology on Friday.

The researchers performed cardiac magnetic resonance imaging on 26 competitive athletes referred to the university’s sports medicine clinic after testing for Covid-19 between June and August. The athletes were involved in football, soccer, lacrosse, basketball and track — and none had illness severe enough to require hospitalization.

Only 12 athletes reported having mild symptoms, such as sore throat, shortness of breath or fever, while others did not show any symptoms, according to the study.

The cardiac imaging was performed after each athlete quarantined for at least 11 days.

The imaging showed that four athletes, or 15%, had findings consistent with myocarditis and eight additional athletes, or 30.8%, had signs of prior myocardial injury. It’s unclear from this study if this inflammation will resolve itself or produce lasting damage.

“Cardiac magnetic resonance imaging has the potential to identify a high-risk cohort for adverse outcomes and may, importantly, risk stratify athletes for safe participation because CMR mapping techniques have a high negative predictive value to rule out myocarditis,” the researchers wrote. “CMR may provide an excellent risk stratification assessment for myocarditis in athletes who have recovered from COVID-19 to guide safe competitive sports participation.”

The study had some limitations, including that the doctors do not have a baseline image of the athletes’ hearts before they had Covid-19. There was also no control group of students who had not had Covid-19.

More research is needed to determine whether similar findings would emerge among a larger group of college athletes from various universities.

Over the summer, Ohio State was among several schools reporting Covid-19 cases within their athletic programs. Ohio State is part of the Big Ten conference, which has announced that it would be postponing all fall sports.

Even before the coronavirus pandemic, it has been recommended that athletes with a probable or definite diagnosis of recent myocarditis not participate in competitive sports while active inflammation is present. This kind of inflammation can weaken the heart, and if it is a severe case, it can lead to heart failure and sudden death.
Some research before the pandemic estimated acute myocarditis and other forms of heart muscle inflammation to be the cause of sudden cardiac death in 5% to 25% of athletes.

Chris Olave #17 of the Ohio State Buckeyes runs the ball against A.J. Terrell #8 of the Clemson Tigers in the first half during the College Football Playoff Semifinal at the PlayStation Fiesta Bowl at State Farm Stadium on December 28, 2019 in Glendale, Arizona. (Photo by Matthew Stockman/Getty Images)

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