Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection: Results From the Big Ten COVID-19 Cardiac Registry.
Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection: Results From the Big Ten COVID-19 Cardiac Registry.
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DOI：
10.1001/jamacardio.2021.2065
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发表时间：
2021-09-01
期刊：
影响因子：
24
通讯作者：
Big Ten COVID-19 Cardiac Registry Investigators
中科院分区：
文献类型：
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作者：
Daniels CJ;Rajpal S;Greenshields JT;Rosenthal GL;Chung EH;Terrin M;Jeudy J;Mattson SE;Law IH;Borchers J;Kovacs R;Kovan J;Rifat SF;Albrecht J;Bento AI;Albers L;Bernhardt D;Day C;Hecht S;Hipskind A;Mjaanes J;Olson D;Rooks YL;Somers EC;Tong MS;Wisinski J;Womack J;Esopenko C;Kratochvil CJ;Rink LD;Big Ten COVID-19 Cardiac Registry Investigators
这项队列研究评估了患有COVID-19的运动员的心肌炎患病率，并比较了安全重返赛场的筛查策略。在COVID-19感染后，竞技运动员心肌炎的患病率如何，不同的筛查方法如何影响检测？在这项队列研究中，1597名美国竞争性大学运动员接受了全面的心血管测试，临床心肌炎的患病率仅为0.31%的基础上，以心脏病为基础的筛查策略。心血管磁共振成像筛查使临床和亚临床心肌炎的患病率增加了7.4%至2.3%。这些心脏磁共振成像结果为从有症状和无症状COVID-19感染中恢复的大学运动员的临床和亚临床心肌炎患病率提供了重要数据。心肌炎是竞技运动员猝死的主要原因。已知SARS-CoV-2会发生心肌炎症。已经报道了用于检测心肌炎的不同筛查方法。十大会议要求对所有患有COVID-19的运动员进行全面的心脏检测，包括心脏磁共振（CMR）成像，以便比较筛查方法。确定患有COVID-19的运动员心肌炎的患病率，并比较安全重返赛场的筛查策略。对十大COVID-19心脏登记中心的主要研究者进行了调查，以获得2020年3月1日至2020年12月15日期间关于COVID-19运动员的综合观察数据。对于患有心肌炎的运动员，记录心脏症状的存在和心脏测试的细节。根据是否存在心脏症状和CMR结果，将心肌炎分类为临床或亚临床。根据其他检测异常，亚临床心肌炎被分类为很可能或可能的心肌炎。确定了各大学的心肌炎患病率。不同的筛选策略的效用进行了评价。通过聚合酶链反应检测SARS-CoV-2。通过心血管诊断测试的心肌炎。代表13所大学，对1597名运动员（964名男性[60.4%]）进行了心血管测试。37人（包括27名男性）被诊断患有COVID-19心肌炎（总体2.3%;每个项目的范围为0%-7.6%）; 9人患有临床心肌炎，28人患有亚临床心肌炎。如果心脏测试仅基于心脏症状，则仅检测到5名运动员（检测到的患病率为0.31%）。所有运动员的心脏磁共振成像检测心肌炎（临床和亚临床）增加了7.4倍。27例（73.0%）患者的随访CMR成像显示T2抬高全部（100%）消退，11例（40.7%）患者出现晚期钆增强。在这项针对1597名美国竞技运动员的队列研究中，37名运动员（2.3%）被诊断为临床和亚临床心肌炎。在各大学的患病率中观察到了变异性，检测方案与心肌炎的检测密切相关。CMR结果的变量确定和未知的影响强调了标准化心脏测试的时间和解释的必要性。这些独特的CMR成像数据提供了对COVID-19感染后大学运动员临床和亚临床心肌炎患病率的更全面了解。CMR在运动员安全返场常规筛查中的作用值得进一步探讨。
This cohort study assesses the prevalence of myocarditis in athletes with COVID-19 and compares screening strategies for safe return to play. What is the prevalence of myocarditis in competitive athletes after COVID-19 infection, and how would different approaches to screening affect detection? In this cohort study of 1597 US competitive collegiate athletes undergoing comprehensive cardiovascular testing, the prevalence of clinical myocarditis based on a symptom-based screening strategy was only 0.31%. Screening with cardiovascular magnetic resonance imaging increased the prevalence of clinical and subclinical myocarditis by a factor of 7.4 to 2.3%. These cardiac magnetic resonance imaging findings provide important data on the prevalence of clinical and subclinical myocarditis in college athletes recovering from symptomatic and asymptomatic COVID-19 infections. Myocarditis is a leading cause of sudden death in competitive athletes. Myocardial inflammation is known to occur with SARS-CoV-2. Different screening approaches for detection of myocarditis have been reported. The Big Ten Conference requires comprehensive cardiac testing including cardiac magnetic resonance (CMR) imaging for all athletes with COVID-19, allowing comparison of screening approaches. To determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play. Big Ten COVID-19 Cardiac Registry principal investigators were surveyed for aggregate observational data from March 1, 2020, through December 15, 2020, on athletes with COVID-19. For athletes with myocarditis, presence of cardiac symptoms and details of cardiac testing were recorded. Myocarditis was categorized as clinical or subclinical based on the presence of cardiac symptoms and CMR findings. Subclinical myocarditis classified as probable or possible myocarditis based on other testing abnormalities. Myocarditis prevalence across universities was determined. The utility of different screening strategies was evaluated. SARS-CoV-2 by polymerase chain reaction testing. Myocarditis via cardiovascular diagnostic testing. Representing 13 universities, cardiovascular testing was performed in 1597 athletes (964 men [60.4%]). Thirty-seven (including 27 men) were diagnosed with COVID-19 myocarditis (overall 2.3%; range per program, 0%-7.6%); 9 had clinical myocarditis and 28 had subclinical myocarditis. If cardiac testing was based on cardiac symptoms alone, only 5 athletes would have been detected (detected prevalence, 0.31%). Cardiac magnetic resonance imaging for all athletes yielded a 7.4-fold increase in detection of myocarditis (clinical and subclinical). Follow-up CMR imaging performed in 27 (73.0%) demonstrated resolution of T2 elevation in all (100%) and late gadolinium enhancement in 11 (40.7%). In this cohort study of 1597 US competitive athletes with CMR screening after COVID-19 infection, 37 athletes (2.3%) were diagnosed with clinical and subclinical myocarditis. Variability was observed in prevalence across universities, and testing protocols were closely tied to the detection of myocarditis. Variable ascertainment and unknown implications of CMR findings underscore the need for standardized timing and interpretation of cardiac testing. These unique CMR imaging data provide a more complete understanding of the prevalence of clinical and subclinical myocarditis in college athletes after COVID-19 infection. The role of CMR in routine screening for athletes safe return to play should be explored further.
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影响因子：
5.6
作者：
Seeherman S;Suzuki YJ
通讯作者：
Suzuki YJ
影响因子：
37.8
作者：
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作者：
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作者：
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通讯作者：
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DOI：
10.1148/ryct.2019190010
发表时间：
2019-08-01
期刊：
RADIOLOGY-CARDIOTHORACIC IMAGING
影响因子：
--
作者：
Luetkens, Julian A.;Faron, Anton;Thomas, Daniel
通讯作者：
Thomas, Daniel