Inflammatory heart disease is rare among professional athletes with mild COVID-19, study finds

Inflammatory heart disease is a rare finding among professional athletes with mild or asymptomatic COVID-19 infection, a large-scale study has found.

The study, led by Columbia University Vagelos College of Physicians and Surgeons in collaboration with the major North American sports leagues and their respective players' associations, was published online today in JAMA Cardiology.

Athletes and COVID-19

Studies suggest that approximately 20% of patients hospitalized with severe COVID-19 develop some type of heart damage, but the impact of mild or asymptomatic infections on the heart is not known.

Viral infections can cause inflammatory heart disease–inflammation in the heart muscle (myocarditis) or the lining of the heart (pericarditis). The condition can trigger abnormal heart rhythms and accounts for approximately 5% of cases of sudden cardiac death in athletes.

"Athletes have a unique risk because of demands on the heart from strenuous exercise, which can increase the risk of abnormal heart rhythms in those with underlying inflammatory heart disease," says David Engel, MD, associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and senior author of the paper.

Early in the COVID-19 pandemic, isolated reports of college and professional athletes who developed heart inflammation were widely publicized, causing alarm among medical professionals, sports leagues, and universities.

In the spring of 2020, the American College of Cardiology (ACC) Sports and Exercise Cardiology section recommended that competitive athletes who test positive for SARS-CoV-2 undergo screening for inflammatory heart disease before returning to the field, court, or ice. The recommendations called for a specific screening protocol with blood tests, electrocardiography, and echocardiography. The guidelines were adopted and implemented across all of the major sports leagues, including Major League Baseball, Major League Soccer, the National Football League, the National Hockey League, and men's and women's National Basketball Associations.

"While all of the major professional leagues had implemented COVID-19 testing programs and the ACC screening protocol, there was no data on how prevalent heart inflammation may be among athletes who tested positive for the coronavirus or how effective the screening program would be to allow athletes to safely return to sport after COVID-19," Engel says. "The leagues realized that if they pooled their screening data, we would soon have an answer."

Very low incidence of heart inflammation in athletes with mild COVID-19

The study included data from 789 professional athletes across the professional leagues who were screened for post-COVID-19 cardiac inflammation. None had severe COVID-19 symptoms, and approximately 40% had very mild or no symptoms.

Abnormal cardiac screening results raising concern for potential COVID-19-associated cardiac injury were found in 30 (3.8%) of the athletes. Further assessment with diagnostic cardiac MRI and cardiac stress tests ultimately found heart inflammation in only five of the athletes (0.6%).

None of the athletes with inflammatory heart disease had a history of heart disease and all were restricted from athletic activities, in accordance with ACC guidelines.

"Our study shows that it is rare for professional athletes with mild COVID-19 to develop heart inflammation, but the risk is not zero," says Engel. "These findings give college and other athletic organizations some clinically relevant context to help them optimize their return-to-play screening protocols with a measure of confidence."