You are here

Article Text

Article menu
Download PDFPDF
Special populations
Original research
Non-COVID-19 cardiovascular pathology from return-to-play screening in college athletes after COVID-19
  1. Christian F Klein1,
  2. Bradley J Petek2,
  3. Nathaniel Moulson3,
  4. Aaron L Baggish4,
  5. Timothy W Churchill5,
  6. Kimberly G Harmon6,
  7. Stephanie A Kliethermes7,
  8. Manesh R Patel8,
  9. Jonathan A Drezner9
  1. 1 Internal Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Centre for Cardiovascular Innovation, The University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Cardiovascular Performance Program, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  6. 6 Family Medicine, University of Washington, Seattle, Washington, USA
  7. 7 Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
  8. 8 Medicine, Duke University, Durham, North Carolina, USA
  9. 9 Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Jonathan A Drezner, University of Washington, Seattle, Washington, USA; jdrezner{at}uw.edu

Abstract

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.

  • COVID-19
  • echocardiography
  • cardiomyopathies
  • aortic aneurysm

Data availability statement

Data are available on reasonable request. ORCCA data are available on reasonable request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/heartjnl-2023-322645

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available on reasonable request. ORCCA data are available on reasonable request.

    View Full Text

    Footnotes

    • Twitter @DreznerJon

    • Contributors CFK and JAD were involved in the conception, design, drafting, revision and final approval of the manuscript. BJP, NM, ALB, TWC, KGH, SAK and MRP were involved in the design, revision and final approval of the manuscript. All authors agreed to be accountable for the accuracy and integrity of all aspects of the work. JAD accepts full responsibility for the overall content and conduct of the study.

    • Funding The authors received funding from the American Medical Society for Sports Medicine, American Heart Association, The Cornette Foundation and The Ron Dolan Endowment in support of the ORCCA study.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.