Prevalence and clinical implications of persistent or exertional cardiopulmonary symptoms following SARS-CoV-2 infection in 3597 collegiate athletes: a study from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA).
Level 3 - non-randomized controlled study
Prospective observational cohort registry study
PubMed 34725052 · doi:10.1136/bjsports-2021-104644
What was done
Data from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) were evaluated for 3,597 US collegiate athletes (mean age 20 years, SD 1 year, 34% female) with confirmed SARS-CoV-2 infection. The study examined clinical characteristics, diagnostic testing (including cardiac MRI [CMR]), and diagnoses of SARS-CoV-2-associated sequelae in athletes reporting persistent symptoms (>3 weeks), exertional cardiopulmonary symptoms upon return to exercise, and those without persistent or exertional symptoms.
What was found
Persistent symptoms >3 weeks were reported in 44/3529 (1.2%) athletes, and >12 weeks in 2/3529 (0.06%). Exertional cardiopulmonary symptoms upon return to exercise occurred in 137/3393 (4.0%). Clinical evaluation and diagnostic testing identified SARS-CoV-2-associated sequelae in 12/137 (8.8%) athletes with exertional symptoms (5 cardiac involvement, 2 pneumonia, 2 inappropriate sinus tachycardia, 2 postural orthostatic tachycardia syndrome, 1 pleural effusion). No sequelae were identified in athletes with isolated persistent symptoms. Among athletes with chest pain on return to exercise who underwent CMR, 5/24 (20.8%) had probable or definite cardiac involvement, compared to 0/20 (0%) in athletes with exertional symptoms without chest pain who underwent CMR.
Why it matters
Persistent and exertional symptoms following SARS-CoV-2 infection are rare in young competitive athletes. However, exertional chest pain on return to play indicates a substantial risk of cardiac involvement that warrants comprehensive diagnostic workup.
Limits
The study population was restricted to young, highly conditioned collegiate athletes, limiting generalizability to older or less active individuals. Advanced diagnostic testing such as CMR was performed selectively rather than universally. Data were missing for subsets of the cohort (persistent symptoms reported in 3,529; exertional symptoms reported in 3,393).
Cited by
- context In Brad Petek's study of approximately 1,600 collegiate athletes with COVID-19, only two athletes (0.06%) experienced symptoms lasting longer than 12 weeks.