Mitrani R D, Alfadhli J, Lowery M H, Best T M, Hare J M, Fishman J, Dong C, Siegel Y, Scavo V, Basham G J, Myerburg R J, Goldberger J J
Department of Medicine, University of Miami, Miller School of Medicine, United States of America.
UHealth Sports Medicine Institute, Department of Orthopedics, University of Miami, Miller School of Medicine, United States of America.
Am Heart J Plus. 2022 Feb;14:100125. doi: 10.1016/j.ahjo.2022.100125. Epub 2022 Mar 31.
This study assessed a functional protocol to identify myocarditis or myocardial involvement in competitive athletes following SARS-CoV2 infection.
We prospectively evaluated competitive athletes (n = 174) for myocarditis or myocardial involvement using the Multidisciplinary Inquiry of Athletes in Miami (MIAMI) protocol, a median of 18.5 (IQR 16-25) days following diagnosis of COVID-19 infection. The protocol included biomarker analysis, ECG, cardiopulmonary stress echocardiography testing with global longitudinal strain (GLS), and targeted cardiac MRI for athletes with abnormal findings. Patients were followed for median of 148 days.
We evaluated 52 females and 122 males, with median age 21 (IQR: 19, 22) years. Five (2.9%) had evidence of myocardial involvement, including definite or probable myocarditis (n = 2). Three of the 5 athletes with myocarditis or myocardial involvement had clinically significant abnormalities during stress testing including ventricular ectopy, wall motion abnormalities and/or elevated VE/VCO2, while the other two athletes had resting ECG abnormalities. VO2, left ventricular ejection fraction and GLS were similar between those with or without myocardial involvement. No adverse events were reported in the 169 athletes cleared to exercise at a median follow-up of 148 (IQR108,211) days. Patients who were initially restricted from exercise had no adverse sequelae and were cleared to resume training between 3 and 12 months post diagnosis.
Screening protocols that include exercise testing may enhance the sensitivity of detecting COVID-19 related myocardial involvement following recovery from SARS-CoV2 infection.
本研究评估了一种功能方案，用于识别感染SARS-CoV2后的竞技运动员中的心肌炎或心肌受累情况。
我们采用迈阿密运动员多学科调查（MIAMI）方案，对174名竞技运动员进行前瞻性评估，以确定是否存在心肌炎或心肌受累，评估时间为确诊COVID-19感染后的中位数18.5天（四分位间距16 - 25天）。该方案包括生物标志物分析、心电图、采用整体纵向应变（GLS）的心肺应激超声心动图检测，以及对有异常发现的运动员进行针对性心脏磁共振成像。对患者进行了中位数为148天的随访。
我们评估了52名女性和122名男性，中位年龄为21岁（四分位间距：19，22岁）。5名（2.9%）有心肌受累的证据，包括确诊或可能的心肌炎（n = 2）。5名患有心肌炎或心肌受累的运动员中有3名在应激测试期间出现了具有临床意义的异常，包括室性早搏、壁运动异常和/或VE/VCO2升高，而另外两名运动员有静息心电图异常。有或无心肌受累者之间的VO2、左心室射血分数和GLS相似。在169名被批准在中位数为148天（四分位间距108,211天）的随访中进行运动的运动员中，未报告不良事件。最初被限制运动的患者没有不良后遗症，在诊断后3至12个月被批准恢复训练。
包括运动测试的筛查方案可能会提高检测从SARS-CoV2感染恢复后与COVID-19相关心肌受累的敏感性。
