Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA.
Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA.
JACC Cardiovasc Imaging. 2021 Mar;14(3):541-555. doi: 10.1016/j.jcmg.2020.10.023. Epub 2020 Nov 4.
This study sought to explore the spectrum of cardiac abnormalities in student athletes who returned to university campus in July 2020 with uncomplicated coronavirus disease 2019 (COVID-19).
There is limited information on cardiovascular involvement in young individuals with mild or asymptomatic COVID-19.
Screening echocardiograms were performed in 54 consecutive student athletes (mean age 19 years; 85% male) who had positive results of reverse transcription polymerase chain reaction nasal swab testing of the upper respiratory tract or immunoglobulin G antibodies against severe acute respiratory syndrome coronavirus type 2. Sequential cardiac magnetic resonance imaging was performed in 48 (89%) subjects.
A total of 16 (30%) athletes were asymptomatic, whereas 36 (66%) and 2 (4%) athletes reported mild and moderate COVID-19 related symptoms, respectively. For the 48 athletes completing both imaging studies, abnormal findings were identified in 27 (56.3%) individuals. This included 19 (39.5%) athletes with pericardial late enhancements with associated pericardial effusion. Of the individuals with pericardial enhancements, 6 (12.5%) had reduced global longitudinal strain and/or an increased native T. One patient showed myocardial enhancement, and reduced left ventricular ejection fraction or reduced global longitudinal strain with or without increased native T values was also identified in an additional 7 (14.6%) individuals. Native T findings were normal in all subjects, and no specific imaging features of myocardial inflammation were identified. Hierarchical clustering of left ventricular regional strain identified 3 unique myopericardial phenotypes that showed significant association with the cardiac magnetic resonance findings (p = 0.03).
More than 1 in 3 previously healthy college athletes recovering from COVID-19 infection showed imaging features of a resolving pericardial inflammation. Although subtle changes in myocardial structure and function were identified, no athlete showed specific imaging features to suggest an ongoing myocarditis. Further studies are needed to understand the clinical implications and long-term evolution of these abnormalities in uncomplicated COVID-19.
本研究旨在探讨 2020 年 7 月患有新冠肺炎（COVID-19）但病情较轻或无症状的大学生运动员的心脏异常谱。
关于轻度或无症状 COVID-19 患者心血管受累的信息有限。
对 54 名连续的大学生运动员进行了筛查超声心动图检查（平均年龄 19 岁；85%为男性），他们的上呼吸道逆转录聚合酶链反应鼻拭子检测或针对严重急性呼吸综合征冠状病毒 2 型的免疫球蛋白 G 抗体结果为阳性。48 名（89%）受试者进行了连续心脏磁共振成像。
共有 16 名（30%）运动员无症状，36 名（66%）和 2 名（4%）运动员分别报告有轻度和中度 COVID-19 相关症状。对于完成两项影像学研究的 48 名运动员，有 27 名（56.3%）个体发现异常。这包括 19 名（39.5%）有心包延迟强化并伴有心包积液的运动员。在心包强化的个体中，6 名（12.5%）有左心室射血分数降低或整体纵向应变降低，或有或无原生 T 值升高。另外 7 名（14.6%）个体也存在左心室射血分数降低或整体纵向应变降低，伴有或不伴有原生 T 值升高。所有受试者的原生 T 值均正常，未发现心肌炎症的特定影像学特征。左心室节段应变的层次聚类确定了 3 种独特的心包心肌表型，与心脏磁共振检查结果有显著相关性（p=0.03）。
在从 COVID-19 感染中恢复的 3 名以上以前健康的大学生运动员中，有影像学特征显示心包炎症正在消退。尽管发现了心肌结构和功能的细微变化，但没有运动员表现出特定的影像学特征表明存在持续性心肌炎。需要进一步研究以了解这些在无症状 COVID-19 中的异常的临床意义和长期演变。
