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Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection

Educational Objective
To understand the latest cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19

Myocarditis is a significant cause of sudden cardiac death in competitive athletes and can occur with normal ventricular function.1 Recent studies have raised concerns of myocardial inflammation after recovery from coronavirus disease 2019 (COVID-19), even in asymptomatic or mildly symptomatic patients.2 Our objective was to investigate the use of cardiac magnetic resonance (CMR) imaging in competitive athletes recovered from COVID-19 to detect myocardial inflammation that would identify high-risk athletes for return to competitive play.

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Article Information

Corresponding Author: Saurabh Rajpal, MBBS, MD, Division of Cardiology, The Ohio State University, 473 W 12th Ave, Columbus, OH 43210 (saurabh.rajpal@osumc.edu).

Accepted for Publication: August 25, 2020.

Published Online: September 11, 2020. doi:10.1001/jamacardio.2020.4916

Author Contributions: Drs Rajpal and Daniels had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Rajpal, Tong, Borchers, Obarski, Simonetti, Daniels.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Rajpal, Tong, Simonetti.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Rajpal, Tong, Obarski.

Administrative, technical, or material support: Rajpal, Tong, Zareba, Simonetti, Daniels.

Supervision: Rajpal, Tong, Borchers, Daniels.

Conflict of Interest Disclosures: Dr Simonetti reports grants from Siemens, Myocardial Solutions, and Cook Medical outside the submitted work. No other disclosures were reported.

References
1.
Maron  BJ , Udelson  JE , Bonow  RO ,  et al; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology.  Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific statement from the American Heart Association and American College of Cardiology.   Circulation. 2015;132(22):e273-e280.PubMedGoogle Scholar
2.
Puntmann  VO , Carerj  ML , Wieters  I ,  et al.  Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19).   JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3557PubMedGoogle Scholar
3.
Messroghli  DR , Moon  JC , Ferreira  VM ,  et al.  Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: a consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI).  [published correction appears in J Cardiovasc Magn Reson. 2018;20(1):9].  J Cardiovasc Magn Reson. 2017;19(1):75. doi:10.1186/s12968-017-0389-8PubMedGoogle ScholarCrossref
4.
Ferreira  VM , Schulz-Menger  J , Holmvang  G ,  et al.  Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations.   J Am Coll Cardiol. 2018;72(24):3158-3176. doi:10.1016/j.jacc.2018.09.072PubMedGoogle ScholarCrossref
5.
Phelan  D , Kim  JH , Chung  EH .  A game plan for the resumption of sport and exercise after coronavirus disease 2019 (COVID-19) infection.   JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.2136PubMedGoogle Scholar
6.
Gräni  C , Eichhorn  C , Bière  L ,  et al.  Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis.  [published correction appears in J Am Coll Cardiol. 2017;70(21):2736].  J Am Coll Cardiol. 2017;70(16):1964-1976. doi:10.1016/j.jacc.2017.08.050PubMedGoogle ScholarCrossref
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