Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening
Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening
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DOI：
10.1001/jamacardio.2021.0565
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发表时间：
2021-03-04
期刊：
影响因子：
24
通讯作者：
Engel, David J.
中科院分区：
文献类型：
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作者：
Martinez, Matthew W.;Tucker, Andrew M.;Engel, David J.
在2019年冠状病毒病（COVID-19）大流行期间，北美主要职业体育联盟是首批恢复全面体育活动的联盟之一。鉴于运动员感染COVID-19后不良心脏后遗症的发生率未知，这些联盟根据美国心脏病学会对所有COVID-19检测呈阳性的运动员的建议，实施了保守的恢复比赛（RTP）心脏测试计划。目的利用当前RTP筛查建议，评估既往感染COVID-19的专业运动员中可检测到的炎症性心脏病的患病率。设计、环境和参与者本横断面研究回顾了2020年5月至10月期间对COVID-19检测呈阳性的专业运动员进行的RTP心脏测试。职业体育联盟（美国职业足球大联盟、美国职业棒球大联盟、美国国家冰球联盟、美国国家橄榄球联盟以及美国国家男子和女子篮球协会）在恢复团队组织的体育活动之前，对所有COVID-19检测呈阳性的球员实施了强制性心脏筛查要求。COVID-19检测结果阳性后进行肌钙蛋白检测、心电图（ECG）和静息超声心动图检查。联盟间，未识别的心脏数据汇总进行集体分析。筛查结果异常的患者接受额外的检查，包括心脏磁共振成像和/或应激超声心动图。主要结果和测量方法可能代表covid -19相关心脏损伤的RTP检测结果异常的发生率，以及初始筛查过程中产生的附加检测的结果和结果。结果纳入789名职业运动员，平均[SD]年龄25岁，其中男性777名，占98.5%。460名运动员（58.3%）既往有新冠肺炎症状，329名运动员（41.7%）无症状或无症状（轻度症状）。检测结果阳性后，平均（SD）为19（17）天（范围3-156天）。30名运动员筛查结果异常（3.8%；肌钙蛋白6名运动员[0.8%]；心电图10名运动员[1.3%]；超声心动图20名运动员[2.5%]），需要进行额外检查；5名运动员（0.6%）最终有心脏磁共振成像结果提示炎症性心脏病（心肌炎，3名；心包炎，2名），导致比赛受限。在接受心脏筛查并恢复职业体育活动的运动员中，没有发生不良心脏事件。本研究提供了大规模数据，评估了当前RTP筛查建议实施情况下相关covid -19相关心脏病理的患病率。虽然正在进行长期随访，但很少发现炎症性心脏病病例，并且迄今为止已实现安全返回专业体育活动。
IMPORTANCE The major North American professional sports leagues were among the first to return to full-scale sport activity during the coronavirus disease 2019 (COVID-19) pandemic. Given the unknown incidence of adverse cardiac sequelae after COVID-19 infection in athletes, these leagues implemented a conservative return-to-play (RTP) cardiac testing program aligned with American College of Cardiology recommendations for all athletes testing positive for COVID-19.OBJECTIVE To assess the prevalence of detectable inflammatory heart disease in professional athletes with prior COVID-19 infection, using current RTP screening recommendations.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study reviewed RTP cardiac testing performed between May and October 2020 on professional athletes who had tested positive for COVID-19. The professional sports leagues (Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men's and women's National Basketball Association) implemented mandatory cardiac screening requirements for all players who had tested positive for COVID-19 prior to resumption of team-organized sports activities.EXPOSURES Troponin testing, electrocardiography (ECG), and resting echocardiography were performed after a positive COVID-19 test result. Interleague, deidentified cardiac data were pooled for collective analysis. Those with abnormal screening test results were referred for additional testing, including cardiac magnetic resonance imaging and/or stress echocardiography.MAIN OUTCOMES AND MEASURES The prevalence of abnormal RTP test results potentially representing COVID-19-associated cardiac injury, and results and outcomes of additional testing generated by the initial screening process.RESULTS The study included 789 professional athletes (mean [SD] age, 25 [3] years; 777 men [98.5%]). A total of 460 athletes (58.3%) had prior symptomatic COVID-19 illness, and 329 (41.7%) were asymptomatic or paucisymptomatic (minimally symptomatic). Testing was performed a mean (SD) of 19 (17) days (range, 3-156 days) after a positive test result. Abnormal screening results were identified in 30 athletes (3.8%; troponin, 6 athletes [0.8%]; ECG, 10 athletes [1.3%]; echocardiography, 20 athletes [2.5%]), necessitating additional testing; 5 athletes (0.6%) ultimately had cardiac magnetic resonance imaging findings suggesting inflammatory heart disease (myocarditis, 3; pericarditis, 2) that resulted in restriction from play. No adverse cardiac events occurred in athletes who underwent cardiac screening and resumed professional sport participation.CONCLUSIONS AND RELEVANCE This study provides large-scale data assessing the prevalence of relevant COVID-19-associated cardiac pathology with implementation of current RTP screening recommendations. While long-term follow-up is ongoing, few cases of inflammatory heart disease have been detected, and a safe return to professional sports activity has thus far been achieved.