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Brito D, Meester S, Yanamala N, Patel HB, Balcik BJ, Casaclang-Verzosa G, Seetharam K, Riveros D, Beto RJ, Balla S, Monseau AJ, Sengupta PP. High Prevalence of Pericardial Involvement in College Student Athletes Recovering From COVID-19. JACC Cardiovasc Imaging 2021; 14:541-555. [PMID: 33223496 PMCID: PMC7641597 DOI: 10.1016/j.jcmg.2020.10.023] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to explore the spectrum of cardiac abnormalities in student athletes who returned to university campus in July 2020 with uncomplicated coronavirus disease 2019 (COVID-19). BACKGROUND There is limited information on cardiovascular involvement in young individuals with mild or asymptomatic COVID-19. METHODS Screening echocardiograms were performed in 54 consecutive student athletes (mean age 19 years; 85% male) who had positive results of reverse transcription polymerase chain reaction nasal swab testing of the upper respiratory tract or immunoglobulin G antibodies against severe acute respiratory syndrome coronavirus type 2. Sequential cardiac magnetic resonance imaging was performed in 48 (89%) subjects. RESULTS A total of 16 (30%) athletes were asymptomatic, whereas 36 (66%) and 2 (4%) athletes reported mild and moderate COVID-19 related symptoms, respectively. For the 48 athletes completing both imaging studies, abnormal findings were identified in 27 (56.3%) individuals. This included 19 (39.5%) athletes with pericardial late enhancements with associated pericardial effusion. Of the individuals with pericardial enhancements, 6 (12.5%) had reduced global longitudinal strain and/or an increased native T1. One patient showed myocardial enhancement, and reduced left ventricular ejection fraction or reduced global longitudinal strain with or without increased native T1 values was also identified in an additional 7 (14.6%) individuals. Native T2 findings were normal in all subjects, and no specific imaging features of myocardial inflammation were identified. Hierarchical clustering of left ventricular regional strain identified 3 unique myopericardial phenotypes that showed significant association with the cardiac magnetic resonance findings (p = 0.03). CONCLUSIONS More than 1 in 3 previously healthy college athletes recovering from COVID-19 infection showed imaging features of a resolving pericardial inflammation. Although subtle changes in myocardial structure and function were identified, no athlete showed specific imaging features to suggest an ongoing myocarditis. Further studies are needed to understand the clinical implications and long-term evolution of these abnormalities in uncomplicated COVID-19.
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Affiliation(s)
- Daniel Brito
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Scott Meester
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Naveena Yanamala
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Heenaben B Patel
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Brenden J Balcik
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Grace Casaclang-Verzosa
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Karthik Seetharam
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Diego Riveros
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Robert James Beto
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Aaron J Monseau
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Partho P Sengupta
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA.
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Clark DE, Parikh A, Dendy JM, Diamond AB, George-Durrett K, Fish FA, Slaughter JC, Fitch W, Hughes SG, Soslow JH. COVID-19 Myocardial Pathology Evaluation in Athletes With Cardiac Magnetic Resonance (COMPETE CMR). Circulation 2020; 143:609-612. [PMID: 33332151 PMCID: PMC7864610 DOI: 10.1161/circulationaha.120.052573] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel E Clark
- Department of Internal Medicine, Division of Cardiovascular Medicine (D.E.C., A.P., J.M.D., F.A.F., S.G.H.), Vanderbilt University Medical Center, Nashville, TN
| | - Amar Parikh
- Department of Internal Medicine, Division of Cardiovascular Medicine (D.E.C., A.P., J.M.D., F.A.F., S.G.H.), Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey M Dendy
- Department of Internal Medicine, Division of Cardiovascular Medicine (D.E.C., A.P., J.M.D., F.A.F., S.G.H.), Vanderbilt University Medical Center, Nashville, TN
| | - Alex B Diamond
- Department of Orthopaedic Surgery and Sports Medicine (A.B.D., W.F.), Vanderbilt University Medical Center, Nashville, TN
| | - Kristen George-Durrett
- Department of Pediatrics, Thomas P. Graham Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (K.G-D., F.A.F., J.H.S.)
| | - Frank A Fish
- Department of Internal Medicine, Division of Cardiovascular Medicine (D.E.C., A.P., J.M.D., F.A.F., S.G.H.), Vanderbilt University Medical Center, Nashville, TN.,Department of Pediatrics, Thomas P. Graham Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (K.G-D., F.A.F., J.H.S.)
| | - James C Slaughter
- Department of Biostatistics (J.C.S.), Vanderbilt University Medical Center, Nashville, TN
| | - Warne Fitch
- Department of Orthopaedic Surgery and Sports Medicine (A.B.D., W.F.), Vanderbilt University Medical Center, Nashville, TN
| | - Sean G Hughes
- Department of Internal Medicine, Division of Cardiovascular Medicine (D.E.C., A.P., J.M.D., F.A.F., S.G.H.), Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan H Soslow
- Department of Pediatrics, Thomas P. Graham Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (K.G-D., F.A.F., J.H.S.)
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