Why the study?
The safe resumption of athletic activity following COVID-19 infection is uncertain due to non-uniform use and interpretation of CMR imaging for myocarditis detection in athletes.
How should cardiovascular magnetic resonance (CMR) imaging be utilized in the return to play assessment of athletes with prior COVID-19 infection?
How should cardiovascular magnetic resonance (CMR) imaging be utilized in the return to play assessment of athletes with prior COVID-19 infection?
This expert consensus document provides guidance on the appropriate use of CMR imaging for evaluating athletes recovering from COVID-19 prior to returning to play.
Answers are grounded in this paper and cite their sources.
Avoids overutilization of CMR in COVID-19; reinforces Level 1 guidance for selective use only.
The global pandemic of coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory suyndrome coronavirus 2 (SARS-CoV-2) is now entering its 4th year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. While pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play, RTP) following resolution of infection. A variety of different testing combinations that leverage the electrocardiogram, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance (CMR) imaging have been proposed and implemented to mitigate risk. CMR in particular affords high sensitivity for myocarditis but has been employed and interpreted non-uniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to RTP. This consensus document synthesizes available evidence to contextualize the appropriate utilization of CMR in the RTP assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.
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Ruberg et al. (2022) conducted a review in COVID-19 infection in athletes. Cardiovascular magnetic resonance (CMR) imaging was evaluated. Cardiovascular magnetic resonance imaging should be applied judiciously in selected cases of symptomatic COVID-19 and abnormal triad testing rather than as a widespread primary screening tool.
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