Key result
Asymptomatic or mild COVID-19 linked to myocardial injury in athletes, requiring return-to-play CV risk stratification.
Why the study?
There is uncertainty about the occurrence and clinical relevance of cardiac injury, including myocarditis, in athletes with asymptomatic or mild COVID-19 infection and the optimal cardiovascular risk stratification approach after infection.
This report provides clinical guidance on cardiovascular risk stratification and return-to-play considerations for athletes recovering from COVID-19, addressing the risk of myocarditis and sudden cardiac death.
Supports cautious pre-return evaluation in athletes after COVID-19; leaves open optimal screening protocols pending prospective trials.
Importance: Cardiac injury with attendant negative prognostic implications is common among patients hospitalized with coronavirus disease 2019 (COVID-19) infection. Whether cardiac injury, including myocarditis, also occurs with asymptomatic or mild-severity COVID-19 infection is uncertain. There is an ongoing concern about COVID-19-associated cardiac pathology among athletes because myocarditis is an important cause of sudden cardiac death during exercise. Observations: Prior to relaxation of stay-at-home orders in the US, the American College of Cardiology's Sports and Exercise Cardiology Section endorsed empirical consensus recommendations advising a conservative return-to-play approach, including cardiac risk stratification, for athletes in competitive sports who have recovered from COVID-19. Emerging observational data coupled with widely publicized reports of athletes in competitive sports with reported COVID-19-associated cardiac pathology suggest that myocardial injury may occur in cases of COVID-19 that are asymptomatic and of mild severity. In the absence of definitive data, there is ongoing uncertainty about the optimal approach to cardiovascular risk stratification of athletes in competitive sports following COVID-19 infection. Conclusions and Relevance: This report was designed to address the most common questions regarding COVID-19 and cardiac pathology in athletes in competitive sports, including the extension of return-to-play considerations to discrete populations of athletes not addressed in prior recommendations. Multicenter registry data documenting cardiovascular outcomes among athletes in competitive sports who have recovered from COVID-19 are currently being collected to determine the prevalence, severity, and clinical relevance of COVID-19-associated cardiac pathology and efficacy of targeted cardiovascular risk stratification. While we await these critical data, early experiences in the clinical oversight of athletes following COVID-19 infection provide an opportunity to address key areas of uncertainty relevant to cardiology and sports medicine practitioners.
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Kim et al. (2020) conducted a review in COVID-19 and cardiac pathology in athletes. COVID-19 infection was evaluated. COVID-19 infection, even when asymptomatic or mild, may cause myocardial injury in competitive athletes, necessitating careful cardiovascular risk stratification before returning to play.
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