Portal de Periódicos da CAPES

Cardiovascular Outcomes in Collegiate Athletes After SARS-CoV-2 Infection: 1-Year Follow-Up From the Outcomes Registry for Cardiac Conditions in Athletes

2022; Lippincott Williams & Wilkins; Volume: 145; Issue: 22 Linguagem: Inglês

10.1161/circulationaha.121.058272

1524-4539

Bradley J. Petek, Nathaniel Moulson, Jonathan A. Drezner, Kimberly G. Harmon, Stephanie Kliethermes‌, Timothy W. Churchill, Manesh R. Patel, Aaron L. Baggish, Irfan M. Asif, Aaron L. Baggish, James Borchers, Jonathan A. Drezner, Katherine M. Edenfield, Michael S. Emery, Kyle Goerl, Brian Hainline, Kimberly G. Harmon, Pei‐Ni Jone, Jonathan H. Kim, Stephanie Kliethermes‌, William E. Kraus, Rachel Lampert, Matthew Leiszler, Benjamin D. Levine, Matthew W. Martinez, Nathaniel Moulson, Francis G. O’Connor, Manesh R. Patel, Bradley J. Petek, Dermot Phelan, Lawrence D. Rink, Herman A. Taylor, Carl J. Ade, Aryan Aiyer, Jarrah Alfadhli, Chloe Amaradio, Scott F. Anderson, Stephanie Arlis-Mayor, Jonathan S. Aubry, Andrea M. Austin, Brenden J. Balcik, Timothy A. Beaver, Nicolas Benitez, Brant Berkstresser, Thomas M. Best, Tiffany Bohon, Jonathan P. Bonnet, Elizabeth Boyington, James E. Bray, Jenna Bryant, Jeffrey Bytomski, Sean Carnahan, Rachel Chamberlain, Samantha Charters, Nicholas Chill, Daniel E. Clark, Douglas Comeau, Laura Cook, Deanna Corey, Amy Costa, Marshall Crowther, Tarun Dalia, Craig Davidson, Kaitlin Davitt, Annabelle de St. Maurice, Peter N. Dean, Jeffrey M. Dendy, Katelyn DeZenzo, Courtney Dimitris, Jeanne Doperak, Calvin Duffaut, Craig Fafara, Katherine Fahy, Jason Ferderber, Megan Finn, Frank A. Fish, R. Warne Fitch, Angelo Galante, Todd Gerlt, Amy Gest, Carla Gilson, Jeffrey J. Goldberger, Joshua Goldman, Erich Groezinger, Jonathan R. Guin, Heather Halseth, Joshua M. Hare, Beth Harness, Nicolas Hatamiya, Julie Haylett, Neal Hazen, Sean G. Hughes, Yeun Hiroi, Amy Hockenbrock, Amanda Honsvall, Jennifer L. Hopp, Julia Howard, Samantha Huba, Mustafa Husaini, Lindsay Huston, Calvin Hwang, Laura Irvin, Val Gene Iven, Robert B. Jones, Donald Joyce, Kristine A. Karlson, Jeremy Kent, Christian F. Klein, Chris Klenck, Michele Kirk, Jordan Knight, Laura Knippa, Madeleine Knutson, Louis E. Kovacs, Yumi Kuscher, Andrea Kussman, Chrissy Landreth, Amy Leu, Dylan Lothian, Maureen H. Lowery, Andrew Lukjanczuk, John M. MacKnight, Lawrence M. Magee, Marja-Liisa Magnuson, Aaron V. Mares, Anne Marquez, Grant McKinley, Scott Meester, Megan Meier, Pranav Mellacheruvu, Christopher O. Miles, Emily S. Miller, Hannah Miller, Raul D. Mitrani, Aaron J. Monseau, Benjamin Moorehead, Robert J. Myerburg, Greg Mytyk, Andrew Narver, Aurelia Nattiv, Laika Nur, Brooke E. Organ, Meredith Pendergast, Frank A. Pettrone, Jordan E. Pierce, Sourav Poddar, Diana Priestman, Ian Quinn, Fred Reifsteck, Morgan Restivo, James B. Robinson, Ryan Roe, Thomas Rosamond, Carrie Rubertino Shearer, Diego Riveros, Miguel Rueda, Takamasa Sakamoto, Brock Schnebel, Ankit B. Shah, Alan Shahtaji, Kevin Shannon, Polly Sheridan‐Young, Jonathon H. Soslow, Siobhan M. Statuta, Mark Stovak, Andrei Tarsici, Kenneth S. Taylor, Kim Terrell, Matt Thomason, Jason Tso, Daniel Vigil, Francis Wang, Jennifer Winningham, Susanna T. Zorn,

Sports injuries and prevention

HomeCirculationVol. 145, No. 22Cardiovascular Outcomes in Collegiate Athletes After SARS-CoV-2 Infection: 1-Year Follow-Up From the Outcomes Registry for Cardiac Conditions in Athletes Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessLetterPDF/EPUBCardiovascular Outcomes in Collegiate Athletes After SARS-CoV-2 Infection: 1-Year Follow-Up From the Outcomes Registry for Cardiac Conditions in Athletes Bradley J. Petek, MD, Nathaniel Moulson, MD, Jonathan A. Drezner, MD, Kimberly G. Harmon, MD, Stephanie A. Kliethermes, PhD, Timothy W. Churchill, MD, Manesh R. Patel, MD and Aaron L. Baggish, MD Bradley J. PetekBradley J. Petek https://orcid.org/0000-0002-6603-2262 Division of Cardiology (B.J.P., T.W.C., A.L.B.), Massachusetts General Hospital, Boston. Cardiovascular Performance Program (B.J.P., T.W.C., A.L.B.), Massachusetts General Hospital, Boston. , Nathaniel MoulsonNathaniel Moulson Division of Cardiology and Sports Cardiology British Columbia, University of British Columbia, Vancouver, Canada (N.M.). , Jonathan A. DreznerJonathan A. Drezner https://orcid.org/0000-0003-3519-9120 Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle (J.A.D., K.G.H.). , Kimberly G. HarmonKimberly G. Harmon https://orcid.org/0000-0002-3670-6609 Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle (J.A.D., K.G.H.). , Stephanie A. KliethermesStephanie A. Kliethermes https://orcid.org/0000-0001-9756-7406 Department of Orthopedics and Rehabilitation, University of Wisconsin Madison (S.A.K.). , Timothy W. ChurchillTimothy W. Churchill https://orcid.org/0000-0002-0215-3049 Division of Cardiology (B.J.P., T.W.C., A.L.B.), Massachusetts General Hospital, Boston. Cardiovascular Performance Program (B.J.P., T.W.C., A.L.B.), Massachusetts General Hospital, Boston. , Manesh R. PatelManesh R. Patel https://orcid.org/0000-0002-2393-0855 Division of Cardiology, Duke Heart Center, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P.). and Aaron L. BaggishAaron L. Baggish Correspondence to: Aaron L. Baggish, MD, Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114. Email E-mail Address: [email protected] https://orcid.org/0000-0003-2042-1489 Division of Cardiology (B.J.P., T.W.C., A.L.B.), Massachusetts General Hospital, Boston. Cardiovascular Performance Program (B.J.P., T.W.C., A.L.B.), Massachusetts General Hospital, Boston. and for the ORCCA Investigators Originally published12 May 2022https://doi.org/10.1161/CIRCULATIONAHA.121.058272Circulation. 2022;145:1690–1692Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: May 12, 2022: Ahead of Print Recent large-scale prospective studies document prevalence estimates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cardiac involvement of 0.5% to 3.0% in young competitive athletes after SARS-CoV-2 infection.1–3 This study was designed to examine cardiovascular outcomes among collegiate athletes after SARS-CoV-2 infection with intermediate term (>1 year) follow-up.This prospective, observational, cohort study included collegiate athlete data submitted to ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) from September 1, 2020, to November 1, 2021. A detailed description has been published.1 Athletes were included if they had confirmed SARS-CoV-2 infection and follow-up for cardiovascular outcomes was available. Follow-up was requested from participating institutions periodically throughout the study period. Adverse cardiovascular events were defined as new clinically significant arrhythmias, clinical heart failure, or sudden cardiac arrest or death. Follow-up time was defined as the date of symptom onset or date of positive SARS-CoV-2 test if asymptomatic to the date of last clinical outcomes update from each institution. SARS-CoV-2 myocardial and myopericardial involvement were defined per previous definitions.1 Continuous variables are presented as mean (SD) or median (interquartile range) as specified. Statistical analyses were performed using R: A Language and Environment for Statistical Computing (2021; R Core Team). All study aspects were approved by the Massachusetts General Brigham Institutional Review Board (protocol 2020P002667) and the need for informed consent was waived. Data from the corresponding author are available on reasonable request.A total of 3675 athletes (age 20±1 years, 33% female, 64% White, 27% Black), representing 45 colleges/universities and 27 unique sporting disciplines, met inclusion criteria for this study (Figure). Cardiovascular testing (ECG, troponin, transthoracic echocardiogram [TTE], or cardiac magnetic resonance imaging [CMR]) was performed in 3564/3675 (97.0%) athletes. Definite or probable SARS-CoV-2 myocardial or myopericardial involvement was diagnosed in 21/3675 (0.6%) athletes (10/21 definite myocardial, 2/21 definite myopericardial, 9/21 probable myopericardial). All athletes with cardiac involvement were restricted from sport after diagnosis and all were successfully cleared to return to sport after exercise restriction (median, 86 days [interquartile range, 33, 90]). One athlete decided not to return to sport despite medical clearance. The remaining athletes successfully returned without complication. Repeat cardiac imaging was performed in 15/21 (71%) athletes before return to play (TTE+CMR, 6 athletes; TTE only, 5 athletes; CMR only, 4 athletes). In the athletes undergoing repeat CMR before their return from sport restriction (median, 86 days [interquartile range, 33, 90]), 7/10 (70%) had complete resolution of initial CMR abnormalities, 1/10 (10%) had partial resolution (resolution of T2 abnormality with persistent late gadolinium enhancement), and 2/10 (20%) had persistent CMR abnormalities (persistent T2 and persistent T1/T2/late gadolinium enhancement abnormalities). After a median follow-up of 1.12 years (interquartile range, 1.06, 1.22), there were 2 (0.05%) adverse cardiovascular events, both in athletes without SARS-CoV-2 cardiac involvement. One athlete had successfully resuscitated sudden cardiac arrest attributed to preexisting genetic structural heart disease unrelated to SARS-CoV-2 infection (initial infection >3 months before sudden cardiac arrest). The other athlete developed new onset atrial fibrillation occurring 1 year of follow-up is low. This includes athletes with uncomplicated SARS-CoV-2 who returned to sport after recommended quarantine and athletes with clinically diagnosed cardiac involvement who underwent more extended, guideline-recommended exercise restriction before return to sport.4 In aggregate, these findings support that cardiac events after SARS-CoV-2 infection are low among athletes with a normal workup and those with cardiac imaging abnormalities suggestive of SARS-CoV-2 cardiac involvement who were temporarily restricted from exercise. Therefore, we recommend that CMR be performed only in athletes with a clinical syndrome consistent with myocarditis and ≥1 abnormal cardiovascular test (eg, ECG, troponin, TTE, ventricular arrhythmias on monitor or stress test) or in athletes with symptoms concerning for myocarditis on return to exercise,5 and athletes with confirmed SARS-CoV-2 infection should undergo exercise restriction per current guidelines.4 Despite these reassuring results, ongoing clinical surveillance of this population will be crucial to clarify the long-term cardiovascular implications of SARS-CoV-2 infection.Article InformationAcknowledgmentsThe authors thank the collaborators of the ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) registry.Sources of FundingThis work was funded in part by a grant from the American Medical Society for Sports Medicine Foundation and American Medical Society for Sports Medicine Collaborative Research Network. Dr Moulson is supported by the University of British Columbia Clinician Investigator Program.Supplemental MaterialMembers of the ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) Study GroupNonstandard Abbreviations and AcronymsCMRcardiac magnetic resonance imagingORCCAOutcomes Registry for Cardiac Conditions in AthletesTTEtransthoracic echocardiogramDisclosures Dr Patel reports advisory board membership for Amgen, Bayer, Janssen, Heartflow, and Medscape; grant funding from the National Heart, Lung, and Blood Institute, Bayer, Janssen, Heartflow, and Idorsia; and his research is supported by the Joel Cournette Foundation for research on athlete's hearts. Dr Baggish has received funding from the National Institutes of Health/National Heart, Lung, and Blood Institute, the National Football Players Association, and the American Heart Association and receives compensation for his role as team cardiologist from the US Olympic Committee/US Olympic Training Centers, US Soccer, US Rowing, the New England Patriots, the Boston Bruins, the New England Revolution, and Harvard University. Dr Harmon has stock options for 98point6, for which she is also on the medical advisory board. The other authors report no conflicts.Footnotes*B.J. Petek and N. Moulson contributed equally.†A list of members of the ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) study group is provided in the Supplemental Material.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.121.058272.For Sources of Funding and Disclosures, see page 1692.Circulation is available at www.ahajournals.org/journal/circCorrespondence to: Aaron L. Baggish, MD, Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114. Email [email protected]orgReferences1. Moulson N, Petek BJ, Drezner JA, Harmon KG, Kliethermes SA, Patel MR, Baggish AL; Outcomes Registry for Cardiac Conditions in Athletes Investigators.SARS-CoV-2 cardiac involvement in young competitive athletes.Circulation. 2021; 144:256–266. doi: 10.1161/CIRCULATIONAHA.121.054824LinkGoogle Scholar2. Daniels CJ, Rajpal S, Greenshields JT, Rosenthal GL, Chung EH, Terrin M, Jeudy J, Mattson SE, Law IH, Borchers J, et al; Big Ten COVID-19 Cardiac Registry Investigators.Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: results from the Big Ten COVID-19 cardiac registry.JAMA Cardiol. 2021; 6:1078–1087. doi: 10.1001/jamacardio.2021.2065CrossrefMedlineGoogle Scholar3. Martinez MW, Tucker AM, Bloom OJ, Green G, DiFiori JP, Solomon G, Phelan D, Kim JH, Meeuwisse W, Sills AK, et al. Prevalence of inflammatory heart disease among professional athletes with prior COVID-19 infection who received systematic return-to-play cardiac screening.JAMA Cardiol. 2021; 6:745–752. doi: 10.1001/jamacardio.2021.0565CrossrefMedlineGoogle Scholar4. Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NA, Cooper LT, Link MS, Maron MS; American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology.Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific statement from the American Heart Association and American College of Cardiology.Circulation. 2015; 132:e273–e280. doi: 10.1161/CIR.0000000000000239LinkGoogle Scholar5. Phelan D, Kim JH, Drezner JA, Elliott MD, Martinez MW, Chung EH, Krishan S, Levine BD, Baggish AL. When to consider cardiac MRI in the evaluation of the competitive athlete after SARS-CoV-2 infection [published online January 27, 2022].Br J Sports Med. doi: 10.1136/bjsports-2021-104750Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Monosilio S, Prosperi S, Squeo M, Spataro S, Spataro A and Maestrini V (2023) Short and Long-Term Cardiovascular Sequelae after SARS-CoV-2 Infection: A Narrative Review Focusing on Athletes, Viruses, 10.3390/v15020493, 15:2, (493) Moulson N, Petek B, Baggish A, Harmon K, Kliethermes S, Patel M, Churchill T and Drezner J (2023) The Cardiac Effects of COVID-19 on Young Competitive Athletes: Results from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA), Journal of Cardiovascular Development and Disease, 10.3390/jcdd10020072, 10:2, (72) Rezler Z, Ko E, Jin E, Ishtiaq M, Papaioannou C, Kim H, Hwang K, Lin Y, Colautti J, Davison K and Thakkar V (2023) The Impact of COVID-19 on the Cardiovascular Health of Emerging Adults Aged 18-25: Findings From a Scoping Review, CJC Pediatric and Congenital Heart Disease, 10.1016/j.cjcpc.2022.11.005, 2:1, (33-50), Online publication date: 1-Feb-2023. Stuber M and Baggish A (2023) Acute Myocardial Injury in the COVID-HEART Study: Emphasizing Scars While Reassuring Scares, Circulation, 147:5, (375-377), Online publication date: 31-Jan-2023. Rahmati M, Koyanagi A, Banitalebi E, Yon D, Lee S, Il Shin J and Smith L (2022) The effect of SARS‐CoV‐2 infection on cardiac function in post‐COVID‐19 survivors: A systematic review and meta‐analysis, Journal of Medical Virology, 10.1002/jmv.28325, 95:1, Online publication date: 1-Jan-2023. Asif I and Toresdahl B (2022) The Parallel Evolution of COVID-19 and Sport, Sports Health: A Multidisciplinary Approach, 10.1177/19417381221116372, 14:5, (614-615), Online publication date: 1-Sep-2022. May 31, 2022Vol 145, Issue 22 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.121.058272PMID: 35545946 Originally publishedMay 12, 2022 KeywordsathletesinfectionsSARS-CoV-2PDF download Advertisement SubjectsExerciseMagnetic Resonance Imaging (MRI)Sudden Cardiac Death