Myocarditis, which is usually caused by a bacterial or viral infection, can disrupt the heart’s rhythm and ability to pump blood, as well as cause long-term damage to the heart muscle in the form of scarring. It’s been connected to up to 20% of all sudden deaths among young athletes.

According to a study presented today at the annual meeting of the Radiological Society of North America, a small but considerable percentage of college athletes with COVID-19 develop myocarditis, a potentially dangerous inflammation of the heart muscle that can only be observed on cardiac MRI.

Myocarditis, which is often caused by a bacterial or viral infection, can damage the heart’s rhythm and capability to pump blood, and it can often result in long-term damage in the form of scarring to the heart muscle.

It has been connected to as many as 20% of all unexpected deaths among young athletes.

COVID-19 outbreak sparked worries about an upsurge in the number of student-athletes who were infected with it.

For this new study, researchers from Big Ten universities collaborated to collect data on the frequency of myocarditis in student-athletes who had recovered from COVID-19 infection. To ensure the safety of athletes who had COVID-19, the conference mandated that all athletes who had the illness undergo a set of heart tests before they could return to the field.

The Big Ten Cardiac Registry’s cardiac MRI core leader is Jean Jeudy, M.D., a professor and radiologist at the University of Maryland School of Medicine in Baltimore. It was the responsibility of this registry to compile all of the Big Ten conference’s data into a single database. 

Dr. Jeudy looked at the results of 1,597 cardiac MRI exams from the 13 schools that took part in the study. There was no selection bias for cardiac MRI because all COVID-positive athletes completed a full battery of cardiac tests, including cardiac MRI, echocardiography, ECG, and blood tests, as well as a thorough medical history.

The study found that 37 athletes, or 2.3 percent, were diagnosed with COVID-19 myocarditis, a rate comparable to the general population’s rate of myocarditis. However, an alarmingly high proportion of myocarditis cases were identified in athletes who did not present with clinical symptoms. Twenty-four individuals (54 percent) with COVID-19 myocarditis had no cardiac symptoms or cardiac testing abnormalities. Only cardiac MRI detected the condition.

“Testing patients for clinical symptoms of myocarditis only captured a small percentage of all patients who had myocardial inflammation,” says Dr. Jeudy. “Cardiac MRI for all athletes yielded a 7.4-fold increase in detection.”

The consequences of myocardial damage revealed by cardiac MRI after COVID-19 are still unknown.

“The main issue is the presence of persistent inflammation and/or myocardial scar,” Dr. Jeudy adds.

“Each of these can be an underlying foundation for additional damage and increased risk of arrhythmia.

“We still don’t know the long-term effects.

“Some athletes had issues that resolved within a month, but we also have athletes with continued abnormalities on their MRI as a result of their initial injury and scarring. There are a lot of chronic issues with COVID-19 that we need to know more about, and hopefully this registry can be one of the major parts of getting that information.”

Researchers will be able to analyze things like changes in exercise function over time thanks to the registry, which will allow them to look beyond the existence of problems.

“These are young patients, and the effects of myocardial inflammation can potentially impact their lives more significantly than in older patients,” says the doctor. “That’s why we really want to push forward and continue to collect this data.”

Cost and a lack of advanced MRI capability at many facilities are important barriers to the widespread use of cardiac MRI in college athletes. However, as the latest study demonstrates, cardiac MRI adds a lot of value to cardiac testing.

“The reality is that there are a small percentage of cases where we know the athletes have an increased risk for sudden death, and using cardiac MRI will increase the number of players who are identified.”

Source: RSNA.org/press21.

Image Credit: iStock

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