Abstract
The COVID-19 pandemic in early 2020 necessitated a global shutdown of organized sports from the recreational level to the Olympic Games. Concerns of potential cardiac sequelae of COVID-19 have created significant challenges for sport and health organizations to design and implement safe return-to-play (RTP) processes for athletes. In response, American College of Cardiology expert consensus RTP screening algorithms have been generated, and updated, for athletes testing positive for COVID-19. This chapter will review the background data forming the basis and impetus for these RTP screening recommendations, provide strategies to enhance the appropriate use and interpretation of the cardiovascular diagnostic components of the screening algorithms, and present insights gained from experience with the implementation of these RTP recommendations that has allowed safe return to sport.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Bibliography
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–64. https://doi.org/10.1016/j.jacc.2018.08.1038.
Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation. 2020;141(20):1648–55. https://doi.org/10.1161/CIRCULATIONAHA.120.046941.
Fried JA, Ramasubbu K, Bhatt R, et al. The variety of cardiovascular presentations of COVID-19. Circulation. 2020;141(23):1930–6. https://doi.org/10.1161/CIRCULATIONAHA.120.047164.
Sandoval Y, Januzzi JLJ, Jaffe AS. Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week. J Am Coll Cardiol. 2020;76(10):1244–58. https://doi.org/10.1016/j.jacc.2020.06.068.
Atri D, Siddiqi HK, Lang JP, Nauffal V, Morrow DA, Bohula EA. COVID-19 for the cardiologist: basic virology, epidemiology, cardiac manifestations, and potential therapeutic strategies. JACC Basic Transl Sci. 2020;5(5):518–36. https://doi.org/10.1016/j.jacbts.2020.04.002.
Lindner D, Fitzek A, Bräuninger H, et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol. 2020. https://doi.org/10.1001/jamacardio.2020.3551.
Libby P. The heart in COVID-19: primary target or secondary bystander? JACC Basic Transl Sci. 2020;5(5):537–42. https://doi.org/10.1016/j.jacbts.2020.04.001.
Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631–7. https://doi.org/10.1002/path.1570.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–7. https://doi.org/10.1111/jth.14768.
Kim JH, Levine BD, Phelan D, et al. COVID-19 and the athletic heart: emerging perspectives on pathology, risks, and return-to-play. JAMA Cardiol. 2021;6(2):219–27. https://doi.org/10.1001/jamacardio.2020.5890.
Phelan D, Kim JH, Elliott MD, et al. Screening of potential cardiac involvement in competitive athletes recovering from COVID-19: an expert consensus statement. JACC Cardiovasc Imaging. 2020;13:2635–52. https://doi.org/10.1016/j.jcmg.2020.10.005.
Maron BJ, Udelson JE, Bonow RO, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific statement From the American Heart Association and American College of Cardiology. Circulation. 2015;132(22):e273–80. https://doi.org/10.1161/CIR.0000000000000239.
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119(8):1085–92. https://doi.org/10.1161/CIRCULATIONAHA.108.804617.
Pelliccia A, Solberg EE, Papadakis M, et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2019;40(1):19–33. https://doi.org/10.1093/eurheartj/ehy730.
Phillips M, Robinowitz M, Higgins JR, Boran KJ, Reed T, Virmani R. Sudden cardiac death in Air Force recruits. A 20-year review. JAMA. 1986;256(19):2696–9.
Kiel RJ, Smith FE, Chason J, Khatib R, Reyes MP. Coxsackievirus B3 myocarditis in C3H/HeJ mice: description of an inbred model and the effect of exercise on virulence. Eur J Epidemiol. 1989;5(3):348–50. https://doi.org/10.1007/BF00144836.
Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020. https://doi.org/10.1001/jamacardio.2020.3557.
Rajpal S, Tong MS, Borchers J, et al. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. JAMA Cardiol. 2020; https://doi.org/10.1001/jamacardio.2020.4916.
Heart condition linked with COVID-19 fuels Power 5 concern about season’s viability. https://www.espn.com/college-football/story/_/id/29633697/heart-condition-linked-covid-19-fuels-power-5-concern-season-viability.
Baggish A, Drezner JA, Kim J, Martinez M, Prutkin JM. Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes. Br J Sports Med. 2020. https://doi.org/10.1136/bjsports-2020-102516.
Vago H, Dohy Z, Merkely B. Cardiac magnetic resonance findings in patients recovered from COVID-19: initial experiences in elite athletes. JACC Cardiovasc Imaging. 2020;S1936-878X:31021–4.
Brito DM, Yanamala N, Heenaben P, et al. High prevalence of pericardial involvement in college student-athletes recovering from COVID-19. JACC Cardiovasc Imaging. 2020;S1936-878X:30946–3.
Starekova J, Bluemke DA, William S Bradham WS, et al. Evaluation for Myocarditis in Competitive Student Athletes Recovering From Coronavirus Disease 2019 With Cardiac Magnetic Resonance Imaging. JAMA Cardiol. 2021;14:e207444. https://doi.org/10.1001/jamacardio.2020.7444. Online ahead of print.
Baggish AL, Battle RW, Beaver TA, et al. Recommendations on the use of multimodality cardiovascular imaging in young adult competitive athletes: a report from the American Society of Echocardiography in collaboration with the Society of Cardiovascular Computed Tomography and the Society for Car. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr. 2020;33(5):523–49. https://doi.org/10.1016/j.echo.2020.02.009.
Shave R, Baggish A, George K, et al. Exercise-induced cardiac troponin elevation: evidence, mechanisms, and implications. J Am Coll Cardiol. 2010;56(3):169–76. https://doi.org/10.1016/j.jacc.2010.03.037.
La Gerche A, Burns AT, Mooney DJ, et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J. 2012;33(8):998–1006. https://doi.org/10.1093/eurheartj/ehr397.
Phelan D, Kim JH, Chung EH. A game plan for the resumption of sport and exercise after coronavirus disease 2019 (COVID-19) infection. JAMA Cardiol. 2020. https://doi.org/10.1001/jamacardio.2020.2136.
Schellhorn P, Klingel K, Burgstahler C. Return to sports after COVID-19 infection: do we have to worry about myocarditis? Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa448.
Wilson MG, Hull JH, Rogers J, et al. Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. Br J Sports Med. 2020;54(19):1157–61. https://doi.org/10.1136/bjsports-2020-102710.
Bhatia RT, Marwaha S, Malhotra A, et al. Exercise in the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) era: a question and answer session with the experts endorsed by the section of sports cardiology & exercise of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol. 2020;27(12):1242–51. https://doi.org/10.1177/2047487320930596.
Phelan D, Kim JH, Elliot MD, et al. Screening of potential cardiac involvement in competitive athletes recovering from COVID-19: an expert consensus statement, vol. 13; 2020. p. 2635–52.
Baggish AL, Levine BD. Icarus and sports after COVID 19: too close to the Sun? Circulation. 2020. https://doi.org/10.1161/CIRCULATIONAHA.120.048335.
Donnellan E, Phelan D. Biomarkers of cardiac stress and injury in athletes: what do they mean? Curr Heart Fail Rep. 2018;15(2):116–22. https://doi.org/10.1007/s11897-018-0385-9.
Kleiven Ø, Omland T, Skadberg Ø, et al. Race duration and blood pressure are major predictors of exercise-induced cardiac troponin elevation. Int J Cardiol. 2019;283:1–8. https://doi.org/10.1016/j.ijcard.2019.02.044.
Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802–10. https://doi.org/10.1001/jamacardio.2020.0950.
Morgera T, Di Lenarda A, Dreas L, et al. Electrocardiography of myocarditis revisited: clinical and prognostic significance of electrocardiographic changes. Am Heart J. 1992;124(2):455–67. https://doi.org/10.1016/0002-8703(92)90613-z.
Engel DJ, Schwartz A, Homma S. Athletic cardiac remodeling in US professional basketball players. JAMA Cardiol. 2016;1(1):80–7. https://doi.org/10.1001/jamacardio.2015.0252.
Abergel E, Chatellier G, Hagege AA, et al. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol. 2004;44(1):144–9. https://doi.org/10.1016/j.jacc.2004.02.057.
Teske AJ, Prakken NH, De Boeck BW, et al. Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes. Eur Heart J. 2009;30(8):969–77. https://doi.org/10.1093/eurheartj/ehp040.
Han Y, Chen T, Bryant J, et al. Society for Cardiovascular Magnetic Resonance (SCMR) guidance for the practice of cardiovascular magnetic resonance during the COVID-19 pandemic. J Cardiovasc Magn Reson. 2020;22(1):26. https://doi.org/10.1186/s12968-020-00628-w.
Huang L, Zhao P, Tang D, et al. Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging. JACC Cardiovasc Imaging. 2020:3427. https://doi.org/10.1016/j.jcmg.2020.05.004.
Sharma S, Drezner JA, Baggish A, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017;69(8):1057–75. https://doi.org/10.1016/j.jacc.2017.01.015.
Martinez MW, Tucker AM, OJ Bloom, et al. Prevalence of Inflammatory Heart Disease Among Professional Athletes with Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening. JAMA Cardiol. 2021;4. https://doi.org/10.1001/jamacardio.2021.0565.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lander, B., Engel, D.J., Phelan, D.M. (2021). The Impact of COVID-19 on Sports Cardiology. In: Engel, D.J., Phelan, D.M. (eds) Sports Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-69384-8_23
Download citation
DOI: https://doi.org/10.1007/978-3-030-69384-8_23
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-69383-1
Online ISBN: 978-3-030-69384-8
eBook Packages: MedicineMedicine (R0)