05 Mar COVID-19: Using Guidelines, Safe Return to Sports is Possible
MedicalResearch.com Interview with:
David J. Engel, MD, FACC
Division of Cardiology
Columbia University Irving Medical Center
New York, New York
MedicalResearch.com: What is the background for this study?
Response: Early reports and observations in the COVID-19 pandemic found that patients recovering from mild to severe forms of COVID-19 illness had a higher prevalence of cardiac injury in comparison with what historically has been seen and reported with other viruses. This cardiac injury, categorized as inflammatory heart disease, could have serious implications, including a risk for exercise-triggered sudden cardiac death, for athletes and highly active people who have had prior COVID-19 illness and who return to intensive exercise activity with unknowing subclinical cardiac injury.
To address these concerns in COVID positive athletes, the ACC generated return to play cardiac screening recommendations (troponin blood test, ECG, resting echocardiogram) for all competitive athletes after COVID-19 infection prior to resumption of competitive and intensive sport activity. The professional leagues were among the first organizations to return to full-scale sport activity in the setting of the pandemic, and they uniformly adopted and implemented the ACC return to play screening recommendations for all athletes that tested positive for COVID-19. The leagues recognized that there was value in collaborating and formally analyzing their pooled cardiac data, not only for league athlete health and safety purposes, but also to share broadly this information to add to the growing body of knowledge about the virus.
MedicalResearch.com: What are the main findings?
Response: What we found is that by using the ACC screening algorithm, few cases of inflammatory heart disease (0.6% of cohort) were ultimately detected, a lower number than we feared may be the case and lower than seen in some prior smaller studies that used cardiac MRI as the primary means to diagnose inflammatory heart disease. The current study is far more clinically practical and reflective of the realities of widespread clinical screening where cardiac MRI is selectively used only in cases where there are abnormalities on the standard screening tests and where the pre-test probability of potential COVID-associated cardiac injury was elevated.
MedicalResearch.com: What should readers take way from your report?
Response: Using the ACC screening recommendations, safe return to sport was achieved for all COVID positive athletes that underwent cardiac screening. Safe return to sport is possible for athletes after COVID-19 infection. For the few athletes where inflammatory heart disease was diagnosed and had to sit out for a period of at least 3-6 months as per AHA/ACC guidelines, follow-up is ongoing to assess the outcomes and cardiac status of these individual athletes.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Longitudinal assessment of athletes with prior COVID-19 infection remains necessary to enhance our understanding of the short-term and potential long-term pathologic cardiac sequelae of COVID-19 infection.
Disclosures are listed in the paper.
Martinez MW, Tucker AM, Bloom OJ, et al. Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening. JAMA Cardiol. Published online March 04, 2021. doi:10.1001/jamacardio.2021.0565
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