Cardiac screening before returning to elite sport after SARS-CoV-2 infection

• Published in: Archives of cardiovascular diseases Vol. 115; no. 11; pp. 562 - 570
• Main Authors: Hédon, Christophe, Schnell, Frédéric, Sosner, Philippe, Chagué, Frédéric, Schuster, Iris, Julia, Marc, Duparc, Alexandre, Guy, Jean-Michel, Molinari, Nicolas, Michaux, Lionel, Cransac, Frédéric, Cade, Stéphane
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Masson SAS 01.11.2022; Elsevier/French Society of Cardiology
• Subjects: Adult; Athletes; Cardiology and cardiovascular system; Clinical Research; COVID-19 - diagnosis; COVID-19 - epidemiology; Female; Heart; Human health and pathology; Humans; Life Sciences; Male; Myocarditis; Return-to-play; SARS-CoV-2; Screening; Young Adult; Myocarditis; Screening; SARS-CoV-2; Return-to-play; CI; RT-PCR; ECG; LVEF; CMR; LGE; Athletes; LVNC
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2022.06.005

•Systematic cardiac evaluation has been proposed in athletes after SARS-CoV-2.•Electrocardiogram and echocardiography are most commonly performed.•Cardiac anomalies after SARS-CoV-2 infection are very rare in athletes.•Hence, cardiac screening may not to be necessary in the absence of cardiac symptoms. SARS-CoV-2 infection can induce cardiac damage. Therefore, in the absence of clear data, a cardiac evaluation was recommended for athletes before returning to play after recent SARS-CoV-2 infection. To assess the proportion of anomalies detected by this cardiac screening. We reviewed the medical files of elite athletes referred for cardiac evaluation before returning to play after a non-hospitalized SARS-CoV-2 infection (based on a positive polymerase chain reaction or antigen test) from March 2020 to July 2021 in 12 French centres. A total of 554 elite athletes (professional or national level) were included (median age 22 years, 72.0% male). An electrocardiogram (ECG), echocardiogram and exercise test were performed in 551 (99.5%), 497 (89.7%) and 293 (52.9%) athletes, respectively. We found anomalies with a potential link with SARS-CoV-2 infection in four ECGs (0.7%), three echocardiograms (0.6%) and three exercise tests (1.0%). Cardiac magnetic resonance imaging was performed in 34 athletes (6.1%), mostly due to abnormal first-line examinations, and was abnormal in one (2.9%). The rates of those abnormalities were not higher among athletes with cardiac symptoms or more severe forms of non-hospitalized SARS-CoV-2 infection. Only one athlete had a possible SARS-CoV-2 myocarditis and sport was temporally contraindicated. None had a major cardiac event declared during the follow-up. The proportion of cardiac involvement after non-hospitalized forms of SARS-CoV-2 infection in athletes are very low. Systematic cardiac screening before returning to play seems to be unnecessary.