COVID-19 study of professional athletes finds few serious cardiac abnormalities

Encouraging news emerged from a COVID-19 cardiac study of professional athletes published in "JAMA Cardiology" on Thursday.

Of the 789 professional athletes from the NBA, WNBA, NFL, NHL, MLB and MLS who tested positive for coronavirus and underwent cardiac screening, just 30 were sent for additional testing and just five were diagnosed with inflammatory heart disease – three with myocarditis and two with pericarditis, according to the study.

As a precaution, the major North American pro sports leagues implemented cardiac screening as part of the return to play protocols for athletes who had the virus.

“What it showed us is that the prevalence of heart-related injury related to COVID-19 is low. That’s very reassuring,” said first author of the study Dr. Matthew Martinez, the director of Atlantic Health System Sports Cardiology at Morristown Medical Center.

Myocarditis is inflammation of the heart muscle that can lead to serious issues, including death. Studies early in the pandemic showed a high prevalence of cardiac abnormalities in COVID-19 in hospitalized, and pericarditis is swelling and irritation of thin tissue around the heart, according to the Mayo Clinic.

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The authors – 16 doctors, including 10 affiliated with all the major pro sports leagues – concluded that the more serious the symptoms, the greater risk for cardiac injury. The athletes who had mild symptoms were less likely to have injury and those with moderate symptoms or worse had a higher chance of cardiac injury.

“If you have no symptoms or just antibodies, we know that the value of identifying that group (cardiac injury) is virtually zero,” Martinez said. “With mild symptoms, we’re not finding a lot of cardiovascular complications. That’s the majority of folks we’re seeing with COVID in this group. If you’re young and otherwise healthy and an athlete and you’re asymptomatic or mild, what you need is rest for a couple of weeks, any additional tests, return to exercise and if you have no symptoms, off you go.

“But if you’re in the moderate risk group where you have systemic illness and persistent fevers, chest pressure, increased heart rate, breathlessness or require a hospitalization, that’s the group we really need to image to make sure that there’s no complication related to COVID. That’s going to be a small number.”

The positive findings extend to athletes at colleges and high schools that may not have the financial and medical resources to conduct screenings or provide cardiac MRIs.

“Our data support the concept that ascertained symptom burden should be a primary reference point to guide the next steps in the evaluation of the athlete testing positive for COVID-19,” the authors wrote in the study.

Said Martinez: “There’s real value in knowing that you're safe to play, most importantly, and that if you get this virus, the vast majority don’t need additional testing – just a little bit of rest.

Cardiac screening for the athletes is three-pronged: troponin testing which can detect heart injury in the blood; electrocardiogram, which measures heart function; and an echocardiogram, which generates images of the heart to assess left ventricular function.

According to the study -- Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening – 759 of the 789 had normal cardiac screening test results and returned to physical activity play after clinical assessments.

The 30 who didn’t had additional testing – either a cardiac MRI, cardiac magnetic imaging or a stress echocardiography. Twenty-five had no cardiac injury and returned to play. The five with inflammatory heart disease were held out. That didn't preclude a return to play after further testing.

Because the pro sports leagues invested in cardiac screening before the pandemic, the athletes will continue to undergo screening. This will help researchers determine if cardiac injury occurs later.

Martinez is also part of a much larger study of college athletes. The study has been submitted, and Martinez said, “I will let that go through the regular process, but I don’t expect any surprises. I think it’s going to be more support.”

Follow Jeff Zillgitt on Twitter @JeffZillgitt