Cardiac inflammation is not a problem for athletes with COVID-19!

One of the biggest news stories late last summer was a report that suggested the majority of young athletes who were mildly ill with COVID-19 developed cardiac problems. Despite being based on flimsy evidence that was refuted almost immediately by experts, this report echoed through athletics at all levels and was largely responsible for plans to cancel the entire college football season. 

It also created copy cat statements as some schools seemed to offer support for the findings. A physician at Penn State made a statement that “half of their football players with COVID-19 had cardiac issues” which subsequently had to be withdrawn because it was not correct. On a personal level it created an argument between me and one of my friends who read my dismissal of the article on this blog. 

Yesterday, the same Journal that had published the initial report, JAMA Cardiology, published a new and much more definitive study showing that any cardiac involvement athletes with COVID-19 had was a very rare phenomenon. 

This cross-sectional study reviewed cardiac testing performed between May and October 2020 on professional athletes who had tested positive for COVID-19. Because of the prior JAMA report, the professional sports leagues (Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men’s and women’s National Basketball Association) had implemented mandatory cardiac screening requirements for all players who had tested positive for COVID-19 prior to resumption of team-organized sports activities.

Troponin testing (a blood marker of cardiac inflammation), electrocardiography (ECG), and resting echocardiography were performed on all athletes after a positive COVID-19 test result. Cardiac data from all subjects were deidentified and pooled for analysis.

The results showed that of the professional athletes who underwent cardiac screening after a positive test for COVID-19, only 0.6% (5 of 789 athletes) had findings suggestive of inflammatory heart disease that limited their return to sports.

While 30 athletes (3.8%) were initially sent for additional cardiac testing as a result of abnormalities on the initial cardiac screening tests, subsequent testing confirmed diagnoses of inflammatory heart disease in only 5 of these athletes (0.6% of the total athlete cohort): 3 athletes with myocarditis (0.4% of the total cohort) and 2 athletes with CMR-confirmed pericarditis (0.3% of the total cohort). 

Myocarditis, the more concerning problem of inflammation in the heart muscle, was reported on only a single test in these athletes and was unclear whether it was actually the result of the COVID-19 illness. Most importantly, as of late December 2020, no clinical cardiac event has occurred in any of the athletes who had undergone cardiac screening and resumed full professional sporting activity.

As we move forward past this pandemic, these findings should reassure anyone with mild COVID-19 that they aren’t likely to develop heart disease. It should also call into question the publication of articles that raise major issues on acute problems like COVID-19 based on small, poorly controlled observations.