SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes.
Level 3 - non-randomized controlled study
Prospective multicenter observational cohort study
PubMed 33866822 · doi:10.1161/CIRCULATIONAHA.121.054824
What was done
A prospective, multicenter observational cohort study across 42 US colleges and universities evaluated collegiate athletes testing positive for SARS-CoV-2 between September 1 and December 31, 2020. Among 19,378 tested athletes, 3,018 positive athletes (mean age 20 years, 32% female) underwent cardiac evaluation. A total of 2,820 athletes underwent cardiac triad testing (12-lead ECG, troponin, transthoracic echocardiography) with reflex cardiac magnetic resonance imaging (CMR) if clinically indicated (n=119), while 198 underwent primary screening CMR. The primary outcome was prevalence of definite, probable, or possible SARS-CoV-2 cardiac involvement using adapted Lake Louise Criteria.
What was found
Abnormal screening findings were detected in 21 of 2,999 (0.7%) on ECG, 24 of 2,719 (0.9%) on troponin, and 24 of 2,556 (0.9%) on echocardiography. Overall, cardiac involvement was identified in 21 of 3,018 athletes (0.7%): 15 of 2,820 (0.5%) in the selective CMR pathway (yield 15 of 119 [12.6%]) versus 6 of 198 (3.0%) in the primary screening CMR pathway. Independent predictors of cardiac involvement included cardiopulmonary symptoms (OR 3.1, 95% CI 1.2–7.7) and at least one abnormal triad test result (OR 37.4, 95% CI 13.3–105.3). Five athletes (0.2%) required hospitalization for noncardiac complications. Over a median follow-up of 113 days (IQR 90–146), 1 adverse cardiac event (0.03%) occurred, deemed likely unrelated to SARS-CoV-2.
Why it matters
This large registry demonstrates that SARS-CoV-2 cardiac involvement and short-term clinical complications are rare in young competitive athletes. It supports symptom- and triad-guided evaluation rather than routine universal screening CMR.
Limits
Median follow-up was limited to 113 days, leaving long-term outcomes unmeasured. Discretionary institutional testing protocols (selective versus universal screening CMR) introduced potential ascertainment bias. Findings in healthy collegiate athletes cannot be generalized to older, non-athletic, or medically complex populations.
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- context Collegiate athletes who had abnormalities on initial COVID triad screening but no cardiopulmonary symptoms had normal cardiac MRI scans.