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Squeo MR, Monosilio S, Gismondi A, Perrone M, Gregorace E, Lemme E, Di Gioia G, Mango R, Prosperi S, Spataro A, Maestrini V, Di Giacinto B, Pelliccia A. Periodic health evaluation in athletes competing in Tokyo 2020: from SARS-CoV-2 to Olympic medals. BMJ Open Sport Exerc Med 2023; 9:e001610. [PMID: 38046277 PMCID: PMC10689352 DOI: 10.1136/bmjsem-2023-001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Background The Tokyo Olympic games were the only games postponed for a year in peacetime, which will be remembered as the COVID-19 Olympics. No data are currently available on the effect on athlete's performance. Aim To examine the Italian Olympic athletes who have undergone the return to play (RTP) protocol after COVID-19 and their Olympic results. Methods 642 Potential Olympics (PO) athletes competing in 19 summer sport disciplines were evaluated through a preparticipation screening protocol and, when necessary, with the RTP protocol. The protocol comprised blood tests, 12-lead resting ECG, transthoracic echocardiogram, cardiopulmonary exercise test, 24-hour Holter-ECG monitoring and cardiovascular MR based on clinical indication. Results Of the 642 PO athletes evaluated, 384 participated at the Olympic Games, 254 being excluded for athletic reasons. 120 athletes of the total cohort of 642 PO were affected by COVID-19. They were evaluated with the RTP protocol before resuming physical activity after a mean detraining period of 30±13 days. Of them, 100 were selected for Olympic Games participation, 16 were excluded for athletic reasons and 4 were due to RTP results (2 for COVID-19-related myocarditis, 1 for pericarditis and 1 for complex ventricular arrhythmias). Among athletes with a history of COVID-19 allowed to resume physical activity after the RTP and selected for the Olympic Games, no one had abnormalities in cardiopulmonary exercise test parameters, and 28 became medal winners with 6 gold, 6 silver and 19 bronze medals. Conclusions Among athletes with COVID-19, there is a low prevalence of cardiac sequelae. For those athletes allowed to resume physical activity after the RTP evaluation, the infection and the forced period of inactivity didn't have a negative impact on athletic performance.
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Affiliation(s)
- Maria Rosaria Squeo
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Sara Monosilio
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Alessandro Gismondi
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Marco Perrone
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Emanuele Gregorace
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Erika Lemme
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Giuseppe Di Gioia
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Ruggiero Mango
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Silvia Prosperi
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Antonio Spataro
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Viviana Maestrini
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Barbara Di Giacinto
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
| | - Antonio Pelliccia
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Roma, Italy
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Maestrini V, Penza M, Filomena D, Birtolo LI, Monosilio S, Lemme E, Squeo MR, Mango R, Di Gioia G, Serdoz A, Fiore R, Fedele F, Pelliccia A, Di Giacinto B. Low prevalence of cardiac abnormalities in competitive athletes at return-to-play after COVID-19. J Sci Med Sport 2023; 26:8-13. [PMID: 36372623 PMCID: PMC9622018 DOI: 10.1016/j.jsams.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE to evaluate the prevalence of cardiac involvement after COVID-19 in competitive athletes at return-to-play (RTP) evaluation, following the recommended Italian protocol including cardiopulmonary exercise test (CPET) and 24-Hour Holter monitoring. DESIGN AND METHODS this is a single centre observational, cross-sectional study. Since October 2020, all competitive athletes (age ≥ 14 years) evaluated in our Institute after COVID-19, prior RTP were enrolled. The protocol dictated by the Italian governing bodies included: 12‑lead ECG, blood test, CPET, 24-h ECG monitoring, spirometry. Cardiovascular Magnetic Resonance (CMR) was performed based on clinical indication. RESULTS 219 consecutive athletes were examined (59% male), age 23 years (IQR 19-27), 21% asymptomatic, 77% mildly symptomatic, 2% with previous pneumonia. The evaluation was performed after a median of 10 (6-17) days from negative SARS-CoV-2 swab. All athletes showed a good exercise capacity at CPET without cardiovascular and respiratory limitations. Uncommon premature ventricular contractions (PVCs) were found in 9.5% (n = 21) at CPET/Holter ECG monitoring. Two athletes (0.9%) were diagnosed with acute myocarditis (by CMR) and another one with new pericardial effusion. All the three athletes were temporally restricted from sport participation. CONCLUSIONS Myocarditis in competitive athletes screened after COVID-19 resolution was detected in a low minority of the cases (0.9%). However, a non-negligible prevalence of uncommon PVCs (9%) was observed, either at CPET and/or Holter ECG monitoring, including all athletes with COVID-19 related cardiovascular abnormalities.
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Affiliation(s)
- Viviana Maestrini
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy,Corresponding author at: Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Marco Penza
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Medical Biotechnology and Translational Medicine, University of Milan, Italy
| | - Domenico Filomena
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Lucia Ilaria Birtolo
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Sara Monosilio
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Erika Lemme
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Maria Rosaria Squeo
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Ruggiero Mango
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Giuseppe Di Gioia
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Andrea Serdoz
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Roberto Fiore
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Francesco Fedele
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy,Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Antonio Pelliccia
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
| | - Barbara Di Giacinto
- Institute of Sport Medicine, Sport and Health, National Italian Olympic Committee, Italy
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Modica G, Bianco M, Sollazzo F, Di Murro E, Monti R, Cammarano M, Morra L, Nifosì FM, Gervasi SF, Manes Gravina E, Zeppilli P, Palmieri V. Myocarditis in Athletes Recovering from COVID-19: A Systematic Review and Meta-Analysis. IJERPH 2022; 19:4279. [PMID: 35409960 PMCID: PMC8998516 DOI: 10.3390/ijerph19074279] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 12/31/2022]
Abstract
Background: To assess the event rates of myocarditis detected by Cardiac Magnetic Resonance (CMR) in athletes who recovered from COVID-19. Methods: A systematic literature search was performed to identify studies reporting abnormal CMR findings in athletes who recovered from COVID-19. Secondary analyses were performed considering increased serum high sensitivity troponin (hs-Tn) levels and electrocardiographic (ECG) and echocardiographic (ECHO) abnormalities. Results: In total, 7988 athletes from 15 studies were included in the analysis. The pooled event rate of myocarditis was 1% (CI 1–2%), reaching 4% in the sub-group analysis. In addition, heterogeneity was observed (I2 43.8%). The pooled event rates of elevated serum hs-Tn levels, abnormal ECG and ECHO findings were 2% (CI 1–5%), 3% (CI 1–10%) and 2% (CI 1–6%), respectively. ECG, ECHO and serum hs-Tn level abnormalities did not show any correlation with myocarditis. Conclusions: The prevalence of COVID-19-related myocarditis in the athletic population ranges from 1 to 4%. Even if the event rate is quite low, current screening protocols are helpful tools for a safe return to play to properly address CMR studies. Trial registration: the study protocol was registered in the PROSPERO database (registration number: CRD42022300819).
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