Return-to-play screening with ECG and TTE identified major non-COVID-19 cardiovascular pathology in 0.2% (1/500) of college athletes, with TTE adding limited value in those with normal ECGs.
Cohort (n=2,900)
Yes
Does return-to-play screening with ECG and TTE identify significant non-COVID-19 cardiovascular pathology in college athletes after COVID-19?
Routine transthoracic echocardiography in post-COVID-19 return-to-play screening for athletes with normal ECGs has a low yield for identifying major non-COVID-19 cardiovascular pathology.
OBJECTIVE: Concerns for cardiac involvement after SARS-CoV-2 infection led to widespread cardiac testing in athletes. We examined incidental non-COVID-19 cardiovascular pathology in college athletes undergoing postinfection return-to-play screening. METHODS: The Outcomes Registry for Cardiac Conditions in Athletes was a nationwide prospective multicentre observational cohort study that captured testing and outcomes data from 45 institutions (September 2020-June 2021). Athletes with an ECG and transthoracic echocardiogram (TTE) and no pre-existing conditions were included. Findings were defined as major (associated with sudden cardiac death or requiring intervention), minor (warrants surveillance), incidental (no follow-up needed) or uncertain significance (abnormal with subsequent normal testing). RESULTS: Athletes with both ECG and TTE (n=2900, mean age 20±1, 32% female, 27% black) were included. 35 (1.2%) had ECG abnormalities. Of these, 2 (5.7%) had TTE abnormalities indicating cardiomyopathy (hypertrophic-1, dilated-1), and 1 with normal TTE had atrial fibrillation. Of 2865 (98.8%) athletes with a normal ECG, 54 (1.9%) had TTE abnormalities: 3 (5.6%) with aortic root dilatation ≥40 mm, 15 (27.8%) with minor abnormalities, 25 (46.3%) with incidental findings and 11 (20.4%) with findings of uncertain significance. Overall, 6 (0.2%) athletes had major conditions; however, coronary anatomy and aortic dimensions were inconsistently reported and pathology may have been missed. CONCLUSION: Major non-COVID-19 cardiovascular pathology was identified in 1/500 college athletes undergoing return-to-play screening. In athletes without ECG abnormalities, TTE's added value was limited to pathological aortic root dilatation in 1/1000 athletes and minor abnormalities warranting surveillance in 1/160 athletes. Two-thirds of findings were incidental or of uncertain significance.
Klein et al. (2023) conducted a cohort in College athletes after COVID-19 infection (n=2,900). Return-to-play screening (ECG and TTE) was evaluated on Incidental non-COVID-19 cardiovascular pathology (major, minor, incidental, or uncertain significance). Return-to-play screening with ECG and TTE identified major non-COVID-19 cardiovascular pathology in 0.2% (1/500) of college athletes, with TTE adding limited value in those with normal ECGs.