Division of Cardiology (N.M., B.J.P., A.L.B.), Massachusetts General Hospital, Boston.
Cardiovascular Performance Program (N.M., B.J.P., A.L.B.), Massachusetts General Hospital, Boston.
Circulation. 2021 Jul 27;144(4):256-266. doi: 10.1161/CIRCULATIONAHA.121.054824. Epub 2021 Apr 17.
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.
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.
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.
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.
在因严重 2019 年冠状病毒病（COVID-19）住院的患者中，心脏受累较为常见，并与不良结局相关。本研究旨在确定美国年轻竞技运动员 COVID-19 心脏受累的患病率及其临床意义。
在这项前瞻性、多中心、观察性队列研究中，我们评估了美国大学生运动员中 COVID-19 心脏受累的患病率、临床特征和结局。数据收集时间为 2020 年 9 月 1 日至 2020 年 12 月 31 日。主要结局是根据从 Lake Louise 影像学标准更新版改编的影像学定义，确定明确、可能或疑似 COVID-19 心脏受累的患病率。次要结局包括心脏检查的诊断率、心脏受累的预测因素以及不良心血管事件或住院情况。
在因严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）感染而接受检测的 19378 名运动员中，有 3018 名（平均年龄 20 岁[标准差 1 岁]；32%为女性）检测结果呈阳性，并接受了心脏评估。共有 2820 名运动员至少接受了心脏三联检测的 1 项检查（12 导联心电图、肌钙蛋白、经胸超声心动图），如果临床需要，则进行心脏磁共振成像（CMR）。相比之下，198 名运动员接受了初次筛查 CMR。心电图（2999 例中的 21 例[0.7%]）、心肌肌钙蛋白（2719 例中的 24 例[0.9%]）和经胸超声心动图（2556 例中的 24 例[0.9%]）提示 SARS-CoV-2 心脏受累的异常发现。21 名（0.7%）运动员被确定为患有明确、可能或疑似 SARS-CoV-2 心脏受累，其中 15 名（2820 名中）进行了临床需要的 CMR（n=119），6 名（198 名中）进行了初次筛查 CMR（n=6）。因此，初次筛查 CMR 检测 SARS-CoV-2 心脏受累的诊断率是临床需要的 CMR（15 例[12.6%]）的 4.2 倍，而不是初次筛查 CMR（6 例[3.0%]）。经过种族和性别调整后，SARS-CoV-2 心脏受累的预测因素包括心肺症状（比值比，3.1[95%CI，1.2，7.7]）或至少 1 项三联检测异常结果（比值比，37.4[95%CI，13.3，105.3]）。5 名（0.2%）运动员因 COVID-19 的非心脏并发症需要住院治疗。在临床随访期间（中位随访时间为 113 天[四分位距 90-146]），发生 1 例（0.03%）不良心脏事件，可能与 SARS-CoV-2 感染无关。
年轻竞技运动员中 SARS-CoV-2 感染与心脏受累的低患病率以及短期随访中临床事件的低风险相关。
