Key result
Return-to-play consensus guidelines correctly identify 1 elite athlete with COVID-19 myocarditis for appropriate CMR evaluation.
Why the study?
Post-viral myocarditis has been associated with sudden cardiac death in athletes, and concerns exist about COVID-19-related myocarditis impacting professional athletes.
Case Report (n=1)
This case illustrates the utility of consensus guidelines and a stepwise approach, including CMR, for evaluating athletes with COVID-19-related myocarditis risk before returning to play.
Supports guideline-directed CMR evaluation in high-risk athletes; leaves open prospective validation for return-to-play protocols.
Background: Post-viral myocarditis has been associated with sudden cardiac death in athletes. Since the beginning of the COVID-19 pandemic, the concern of post-viral myocarditis impacting the professional athletic community has been present. Case summary: An elite-level basketball player presented after a positive COVID-19 test with findings consistent with ventricular tachycardia related to myocardial fibrosis/scar from a COVID-19-related myocarditis. Although rare, COVID-19 myocarditis can occur. This case illustrates how the consensus guidelines for return-to-play correctly identified the player as high risk with appropriate downstream evaluation by cardiac magnetic resonance (CMR) imaging. The stepwise approach is illustrated in this case and highlights the utility and success of the algorithm when approaching athletes with COVID-19-related myocarditis risk and determining a return to exercise. Discussion: Diligence is required to identify competitive athletes with features suggestive of myocarditis at the initial presentation and with the return to exercise. Cardiopulmonary symptoms in the setting of recent COVID-19 infection should prompt additional testing in a stepwise fashion and often benefit from CMR in addition to the triad testing with electrocardiography, echocardiography, and cardiac troponin measurement to further investigate clinical presentations of COVID-19-related myocarditis.
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Abdelfattah et al. (2023) conducted a case report in COVID-19-related myocarditis (n=1). Consensus guidelines for return-to-play and cardiac magnetic resonance (CMR) imaging was evaluated on Identification of high risk and appropriate downstream evaluation. Consensus guidelines for return-to-play correctly identified 1 elite athlete with COVID-19-related myocarditis as high risk, prompting appropriate evaluation by cardiac magnetic resonance imaging.
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