Casasco Maurizio, Iellamo Ferdinando, Scorcu Marco, Parisi Attilio, Tavcar Irena, Brugin Erica, Martini Barbara, Fossati Chiara, Pigozzi Fabio
Italian Federation of Sports Medicine (FMSI), 00196 Rome, Italy.
Post-Graduate School of Sport Medicine and Physical Exercise, University Tor Vergata, 00173 Rome, Italy.
J Cardiovasc Dev Dis. 2022 Feb 15;9(2):59. doi: 10.3390/jcdd9020059.
SARS-CoV-2 can lead to several systemic complications, including myocardial injuries; these might be worsened by heavy physical activity. The optimal approach to cardiac risk stratification following SARS-CoV-2 infection in athletes for a safe return to play (RTP) still needs defining. The aim of this study was to assess the prevalence of abnormal RTP test results, according to the protocol of Italian Federation of Sport Medicine (FMSI), which was endorsed by the Italian Ministry of Health, potentially representing COVID-19-associated cardiac injuries.
This was a prospective, multicenter, observational study. All consecutive competitive athletes who underwent COVID-19 RTP testing protocol from 1 May to 31 July 2021, across 60 Italian Centers of Sports Medicine, were enrolled in the study. Athletes were tested at least 30 days after negativization of the nasopharyngeal swab (or immediately after negativization in professional athletes or Probable Olympians). A 12-lead electrocardiography at rest and during maximal incremental exercise test with continuous O saturation monitoring and an echocardiographic examination were part of the protocol. In athletes with "moderate" disease (NHI classification), 24 h ECG monitoring (to be performed on a training day) and Magnetic Resonance Imaging (MRI) were also performed.
A total of 4143 athletes (67.8% males and 32.2% females) (53% > 18 years, 20% 18-35 years and 16% > 35 years), from more than 40 different sport disciplines, were included in the study. The mean age was 22.5 ± 13.3 years, with ages ranging from 8 to 80 years. Of these athletes, 52.3% were asymptomatic, 46.4% manifested mild symptoms, 1.1% and 0.14% had moderate or severe symptoms, respectively, while critical illness was evident in one athlete. Abnormal echocardiographic findings were detected in 80 cases (1.9%), and pericarditis in 7 cases (0.2%); all were from mildly symptomatic athletes. Arrhythmic events were recorded in 239 athletes, with 224 (5.4%) in the exercise test and 15 (0.4%) during 24 h ECG monitoring. Ventricular arrhythmias were observed in 101 (2.4%) athletes from the total population (mostly isolated or couples of premature ventricular beats): 91 in the exercise test and 10 during 24 h ECG monitoring. Cardiac magnetic resonance was performed in 34 athletes; the presence of myocarditis was confirmed in 5 athletes (0.12% of the total population, 14.7% of athletes in which MRI was performed).
According to our results, cardiac complications from SARS-CoV-2 in asymptomatic or mildly symptomatic competitive athletes are rare, and an RTP assessment based on symptoms and ECG-monitored exercise test would ensure a safe RTP in these athletes.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可导致多种全身并发症，包括心肌损伤；剧烈体育活动可能会使这些并发症恶化。对于感染SARS-CoV-2的运动员，为安全恢复比赛（RTP）进行心脏风险分层的最佳方法仍有待确定。本研究的目的是根据意大利运动医学联合会（FMSI）的方案评估RTP测试异常结果的发生率，该方案得到了意大利卫生部的认可，可能代表与新型冠状病毒肺炎相关的心脏损伤。
这是一项前瞻性、多中心、观察性研究。2021年5月1日至7月31日期间，在意大利60个运动医学中心接受新型冠状病毒肺炎RTP检测方案的所有连续竞技运动员均纳入本研究。运动员在鼻咽拭子转阴至少30天后进行检测（职业运动员或可能参加奥运会的运动员在转阴后立即进行检测）。静息及最大递增运动试验时的12导联心电图检查、连续血氧饱和度监测及超声心动图检查均为该方案的一部分。对于“中度”疾病（NHI分类）的运动员，还进行了24小时心电图监测（在训练日进行）和磁共振成像（MRI）检查。
本研究共纳入4143名运动员（男性占67.8%，女性占32.2%）（53%年龄大于18岁，20%年龄在18至35岁之间，16%年龄大于35岁），来自40多个不同的运动项目。平均年龄为22.5±13.3岁，年龄范围为8至80岁。这些运动员中，52.3%无症状，46.4%表现为轻度症状，1.1%和0.14%分别有中度或重度症状，而1名运动员有危重症表现。80例（1.9%）检测到超声心动图异常，7例（0.2%）检测到心包炎；所有这些均来自有轻度症状的运动员。239名运动员记录到心律失常事件，其中运动试验中有224例（5.4%），24小时心电图监测中有15例（0.4%）。在全部人群中，101名（2.4%）运动员观察到室性心律失常（大多为孤立性或成对室性早搏）：运动试验中有91例，24小时心电图监测中有10例。34名运动员进行了心脏磁共振成像检查；5名运动员确诊为心肌炎（占总人群的0.12%，占进行MRI检查运动员的14.7%）。
根据我们的研究结果，无症状或轻度症状的竞技运动员中，SARS-CoV-2引起的心脏并发症很少见，基于症状和心电图监测的运动试验进行RTP评估可确保这些运动员安全恢复比赛。
