Cardiac Troponin Testing as a Component of Return to Play Cardiac Screening in Young Competitive Athletes Following SARS-CoV-2 Infection.
Level 3 - non-randomized controlled study
Prospective observational cohort study evaluating diagnostic yield
PubMed 35929475 · doi:10.1161/JAHA.122.025369
What was done
A prospective observational cohort study evaluated 3,184 collegiate athletes (mean age 20±1 years, 32% female, 28% Black) enrolled in the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) database who underwent cardiac troponin (cTn) testing as part of post-SARS-CoV-2 return-to-play protocols. Testing occurred at a median of 13 days (interquartile range, 11–18 days) post-infection. Values were categorized as undetectable, detectable within normal limits, or abnormal (>99th percentile) and evaluated against diagnoses of probable or definite SARS-CoV-2 myocardial involvement established through cardiac imaging.
What was found
Of 3,184 athletes, cTn was undetectable in 2,942 (92%), detectable within normal limits in 210 (7%), and abnormal in 32 (1%). Among the 32 athletes with abnormal cTn, 19 (59%) underwent cardiac magnetic resonance imaging, 30 (94%) underwent transthoracic echocardiography, and 1 (3%) had no imaging; only 1 athlete met criteria for definite or probable myocardial involvement. Across the full cohort, 21 of 3,184 athletes (0.7%) had SARS-CoV-2 myocardial involvement, of whom 20 (95%) had normal cTn levels.
Why it matters
Universal cardiac troponin screening in competitive athletes recovering from SARS-CoV-2 has very low diagnostic yield and missed 95% of myocardial involvement cases. These data argue against routine biomarker screening in unselected athletic return-to-play protocols.
Limits
The population was limited to young collegiate athletes (average age 20), limiting generalizability to pediatric, older, or non-athlete populations. Downstream imaging was incomplete (only 59% with abnormal troponin received cardiac magnetic resonance imaging) and not systematically applied to all normal-troponin participants. The median 13-day delay between diagnosis and testing may have missed transient early troponin elevations.
Cited by
- supports Collegiate athletes who had abnormalities on initial COVID triad screening but no cardiopulmonary symptoms had normal cardiac MRI scans.