Tasca J S, Bianchi G, Girardello A, Lucchini A, Cappelli C
Department of Clinical and Experimental Sciences, Postgraduate School of Sport Medicine and Physical Exercise, University of Brescia, Brescia 25123, Italy.
Sci Sports. 2022 May;37(3):167-175. doi: 10.1016/j.scispo.2021.05.009. Epub 2022 Feb 7.
The aim of the present study was to conduct a review of the current literature evaluating the available evidence to date in terms of epidemiology, pathophysiology and clinical presentation of COVID-19 in relation to cardiovascular involvement, with a special focus on the myocarditis model, in the population of athletes (professional and recreational) who are preparing to return to competitions, with the ultimate aim of guaranteeing maximum safety for resuming sports activities.
The COVID-19 pandemic has resulted in the inevitable cancellation of most sports activities, practiced at both a professional and amateur level, in order to minimize the risk of spreading the infection. Since the number of athletes who tested positive was rather high, the potential cardiac involvement in this peculiar population of subjects contracting the disease in a mild (asymptomatic, slightly symptomatic) or moderate form, has recently raised concerns following the observation of cases of recorded myocardial damage, myocarditis, arrhythmias and a first reported case of Sudden Cardiac Death (SCD) in a 27-year-old professional basketball player. Several studies even seem to confirm the possibility of permanent impairment of the cardiorespiratory system following the infection. Medical history, biomarkers, electrocardiographical and cardiac imaging features appear to be crucial in distinguishing cardiovascular alterations related to COVID-19 infection from typical adaptations to exercise related to athletes' heart.
Clarifications and prospective data based on long-term follow-ups on larger populations of athletes are still needed to exclude the development of myocardial damage capable of negatively affecting prognosis and increasing cardiovascular risk in athletes recovered from COVID-19 in asymptomatic (simple positivity to SARS-COV-2) or in a mild form.
From a clinical point of view extreme caution is necessary when planning the return to sport (Return To Play-RTP) of athletes recovered from a mild or asymptomatic form of COVID-19: a careful preliminary medical-sports evaluation should be carried out in order to assess the potential development of myocardial damage that would increase their cardiovascular risk.
本研究旨在回顾当前文献，评估迄今为止关于新型冠状病毒肺炎（COVID-19）在心血管受累方面的流行病学、病理生理学和临床表现的现有证据，特别关注心肌炎模型，研究对象为准备恢复比赛的运动员群体（职业和业余），最终目的是确保恢复体育活动的最大安全性。
COVID-19大流行导致大多数职业和业余水平的体育活动不可避免地取消，以尽量降低感染传播风险。由于检测呈阳性的运动员数量相当多，在观察到有心肌损伤、心肌炎、心律失常病例以及一名27岁职业篮球运动员首次报告的心源性猝死（SCD）病例后，这种特殊人群感染该疾病后潜在的心脏受累最近引发了关注。几项研究甚至似乎证实了感染后心肺系统永久性损害的可能性。病史、生物标志物、心电图和心脏成像特征在区分与COVID-19感染相关的心血管改变和与运动员心脏相关的典型运动适应性改变方面似乎至关重要。
仍需要基于对更多运动员群体的长期随访的明确信息和前瞻性数据，以排除在无症状（SARS-CoV-2单纯阳性）或轻度感染COVID-19后康复的运动员中可能出现的对预后产生负面影响并增加心血管风险的心肌损伤。
从临床角度来看，在规划从轻度或无症状形式的COVID-19中康复的运动员恢复运动（重返赛场-RTP）时，必须极其谨慎：应进行仔细的初步医学-体育评估，以评估可能增加其心血管风险的心肌损伤的潜在发展情况。
