Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement

Autor: Phelan, Dermot, Kim, Jonathan H., Elliott, Michael D., Wasfy, Meagan M., Cremer, Paul, Johri, Amer M., Emery, Mike, Sengupta, Partho P., Sharma, Sanjay, Martinez, Matthew W., La Gerche, Andre
Rok vydání: 2020
Předmět:
Competitive Behavior
Consensus
Heart Diseases
Computed Tomography Angiography
SARS–CoV-2
severe acute respiratory syndrome coronavirus 2
POCUS
point-of-care ultrasound
Coronary Angiography
Multimodal Imaging
Risk Assessment
PET
positron emission tomography
State-of-the-Art Paper
hs-cTn
high-sensitivity cardiac troponin
PCR
polymerase chain reaction
Predictive Value of Tests
Risk Factors
COVID-19
coronavirus disease–19
EF
ejection fraction
EICR
exercise-induced cardiac remodeling
Humans
myocardial injury
return-to-play
LGE
late gadolinium enhancement
CV
cardiovascular
CCTA
coronary computed tomography angiography
COVID-19
multi-modality imaging
PPE
pre-participation physical evaluation
Prognosis
CMR
cardiac magnetic resonance imaging
Magnetic Resonance Imaging
Return to Sport
RV
right ventricle
LV
left ventricle
Cardiorespiratory Fitness
TTE
transthoracic echocardiography
Athletes
Echocardiography
GLS
global longitudinal strain
ECG
electrocardiogram
athlete
myocarditis
RTP
return-to-play
Tomography
Emission-Computed
Zdroj: Jacc. Cardiovascular Imaging
ISSN: 1876-7591
Popis: As our understanding of the complications of coronavirus disease–2019 (COVID-19) evolve, sub-clinical cardiac pathology such as myocarditis, pericarditis and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern. The potential implications of these findings in athletes are significant given the concern that exercise, during the acute phase of viral myocarditis, may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias. Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID-19 in order to permit safe return-to-play. Cardiac imaging is at the center of these evaluations. This review seeks to evaluate the current evidence regarding COVID-19associated cardiovascular disease and how multi-modality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection. Guidance is provided with diagnostic “red flags” that raise the suspicion of pathology. Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from sub-clinical cardiac disease. The strengths and limitations of different imaging modalities are discussed and an approach to return-to-play decision making for athletes’ post COVID-19, as informed by multi-modality imaging, is provided.
Highlights: • COVID-19 may cause potential long-term cardiopulmonary complications in athletes, raising concern regarding return to play (RTP). • Exercise induced cardiac remodeling may be misinterpreted as COVID-19 related cardiac injury. • We discuss the strengths and limitations of relevant imaging modalities and an approach to RTP decision making. • Registry data of cardiac testing and outcomes in athletes after COVID-19 is needed to guide future screening strategies.
Databáze: OpenAIRE
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