Utility of exercise testing to assess athletes for post COVID-19 myocarditis

R D Mitrani; J Alfadhli; M H Lowery; T M Best; J M Hare; J Fishman; C Dong; Y Siegel; V Scavo; G J Basham; R J Myerburg; J J Goldberger

doi:10.1016/j.ahjo.2022.100125

Utility of exercise testing to assess athletes for post COVID-19 myocarditis

Am Heart J Plus. 2022 Feb:14:100125. doi: 10.1016/j.ahjo.2022.100125. Epub 2022 Mar 31.

Authors

R D Mitrani¹, J Alfadhli¹, M H Lowery¹, T M Best², J M Hare^{1

3}, J Fishman⁴, C Dong⁵, Y Siegel⁴, V Scavo⁶, G J Basham⁷, R J Myerburg¹, J J Goldberger¹

Affiliations

¹ Department of Medicine, University of Miami, Miller School of Medicine, United States of America.
² UHealth Sports Medicine Institute, Department of Orthopedics, University of Miami, Miller School of Medicine, United States of America.
³ The Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, United States of America.
⁴ Department of Radiology, University of Miami, Miller School of Medicine, United States of America.
⁵ Department of Neurology, University of Miami, Miller School of Medicine, United States of America.
⁶ Department of Intercollegiate Athletics, University of Miami, United States of America.
⁷ Miami Marlins, United States of America.

Abstract

Purpose: This study assessed a functional protocol to identify myocarditis or myocardial involvement in competitive athletes following SARS-CoV2 infection.

Methods: We prospectively evaluated competitive athletes (n = 174) for myocarditis or myocardial involvement using the Multidisciplinary Inquiry of Athletes in Miami (MIAMI) protocol, a median of 18.5 (IQR 16-25) days following diagnosis of COVID-19 infection. The protocol included biomarker analysis, ECG, cardiopulmonary stress echocardiography testing with global longitudinal strain (GLS), and targeted cardiac MRI for athletes with abnormal findings. Patients were followed for median of 148 days.

Results: We evaluated 52 females and 122 males, with median age 21 (IQR: 19, 22) years. Five (2.9%) had evidence of myocardial involvement, including definite or probable myocarditis (n = 2). Three of the 5 athletes with myocarditis or myocardial involvement had clinically significant abnormalities during stress testing including ventricular ectopy, wall motion abnormalities and/or elevated VE/VCO2, while the other two athletes had resting ECG abnormalities. VO2_max, left ventricular ejection fraction and GLS were similar between those with or without myocardial involvement. No adverse events were reported in the 169 athletes cleared to exercise at a median follow-up of 148 (IQR108,211) days. Patients who were initially restricted from exercise had no adverse sequelae and were cleared to resume training between 3 and 12 months post diagnosis.

Conclusions: Screening protocols that include exercise testing may enhance the sensitivity of detecting COVID-19 related myocardial involvement following recovery from SARS-CoV2 infection.

Keywords: CPET, cardiopulmonary exercise test; Cardiac MRI; Cardiac injury; Covid-19; ECG, electrocardiogram; ECHO, echocardiogram; EF, ejection fraction; GLS, global longitudinal strain; LGE, late gadolinium enhancement; LV, left ventricular; MIAMI, Multidisciplinary Inquiry of Athletes in Miami In COVID-19 recovery; MRI, magnetic resonance imaging; Myocarditis; Ventricular arrhythmia.

Abstract

Grants and funding