SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes
SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes
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DOI：
10.1161/circulationaha.121.054824
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发表时间：
2021-07-27
期刊：
影响因子：
37.8
通讯作者：
Baggish, Aaron L.
中科院分区：
文献类型：
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作者：
Moulson, Nathaniel;Petek, Bradley J.;Baggish, Aaron L.
背景：严重冠状病毒病2019(新冠肺炎)住院患者的心脏损害是常见的，并与不良结局相关。本研究旨在确定年轻竞技运动员新冠肺炎心脏受累的患病率及其临床意义。方法：在这项前瞻性、多中心、观察性队列研究中，我们利用来自42所高校的数据，评估了美国大学运动员中新冠肺炎心脏受累的患病率、临床特征和预后。数据收集时间为2020年9月1日至2020年12月31日。主要结果是根据更新的路易斯湖成像标准改编的成像定义，确定的、可能的或可能的新冠肺炎心脏受累的流行率。次要结果包括心脏测试的诊断率，心脏受累的预测因素，以及不良心血管事件或住院。结果：在19378名严重急性呼吸综合征冠状病毒(SARS-CoV-2)感染的运动员中，3018名(平均年龄20岁，SD，1岁；女性占32%)呈阳性，并接受了心脏评估。共有2820名运动员接受了至少一项心脏三联试验(12导联心电图、肌钙蛋白、经胸超声心动图)，随后进行了心脏磁共振成像(CMR)(如果临床有指征)。相比之下，对198名运动员进行了初步筛查。心电图(21/2999，0.7%)、心肌肌钙蛋白(24/2719，0.9%)和经胸超声心动图(24/2556，0.9%)发现了提示SARS-CoV-2心脏受累的异常发现。在3018名运动员中，有21名(0.7%)确定了确定的、可能的或可能的SARS-CoV-2心脏受累，其中包括接受临床指征CMR的2820名运动员中的15名(0.5%)和接受初步筛查CMR的198名运动员中的6名(3.0%)。因此，CMR对SARS-CoV-2心脏损害的诊断效率是临床表现CMR(119例中的15例[12.6%])的4.2倍，而初级筛查CMR(198例中的6例[3.0%])。在调整种族和性别后，预测SARS-CoV-2心脏受累的因素包括心肺症状(优势比，3.1[95%CI，1.2，7.7])或至少1项三联试验异常结果(优势比，37.4[95%CI，13.3,105.3])。5名运动员(0.2%)因新冠肺炎的非心脏并发症而住院。在临床监测期间(中位随访113天[四分位数范围=90 146])，有1例(0.03%)发生不良心脏事件，可能与SARS-CoV-2感染无关。结论：年轻竞技运动员中SARS-CoV-2感染与心脏受累的低发生率和短期随访中临床事件的低风险有关。
Background: Cardiac involvement among hospitalized patients with severe coronavirus disease 2019 (COVID-19) is common and associated with adverse outcomes. This study aimed to determine the prevalence and clinical implications of COVID-19 cardiac involvement in young competitive athletes. Methods: In this prospective, multicenter, observational cohort study with data from 42 colleges and universities, we assessed the prevalence, clinical characteristics, and outcomes of COVID-19 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020, to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible COVID-19 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Imaging Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Results: Among 19 378 athletes tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 3018 (mean age, 20 years [SD, 1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least 1 element of cardiac triad testing (12-lead ECG, troponin, transthoracic echocardiography) followed by cardiac magnetic resonance imaging (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21 of 2999 [0.7%]), cardiac troponin (24 of 2719 [0.9%]), and transthoracic echocardiography (24 of 2556 [0.9%]). Definite, probable, or possible SARS-CoV-2 cardiac involvement was identified in 21 of 3018 (0.7%) athletes, including 15 of 2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6 of 198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-CoV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15 of 119 [12.6%]) versus a primary screening CMR (6 of 198 [3.0%]). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (odds ratio, 3.1 [95% CI, 1.2, 7.7]) or at least 1 abnormal triad test result (odds ratio, 37.4 [95% CI, 13.3, 105.3]). Five (0.2%) athletes required hospitalization for noncardiac complications of COVID-19. During clinical surveillance (median follow-up, 113 days [interquartile range=90 146]), there was 1 (0.03%) adverse cardiac event, likely unrelated to SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short-term follow-up.