Review of COVID-19 Myocarditis in Competitive Athletes: Legitimate Concern or Fake News?

Cardiovascular Concerns from COVID-19 in Pilots

BACKGROUND: Cardiovascular disease, now complicated by the COVID-19 pandemic, remains a leading cause of death and risk for sudden incapacitation for pilots during flight. The capacity for aeromedically significant cardiovascular sequelae with potentially imperceptible clinical symptoms elicits concern both during and following resolution of acute COVID-19 in pilots.OBJECTIVE: We summarize the current state of knowledge regarding COVID-19 cardiovascular implications as applied to the aviation environment to better understand their significance toward flight safety and application toward a focused cardiovascular screening protocol following recovery from infection.METHODS: A narrative review of the cardiovascular implications of COVID-19 infection was performed using the PubMed literature search engine and existing organizational guidelines. In addition, to established medical aviation benchmarks, surrogate populations examined included high performance athletes (as a correlate for high G-forces), and scuba divers (as an environmental work analog). Conditions of primary concern included myocardial injury, proarrhythmic substrates, risk of sudden death, myopericarditis, pulse orthostatic lability in response to vigorous activity, cardiovagal dysfunction, and thromboembolic disease.LITERATURE REVIEW: Cardiovascular screening guideline recommendations post-infection recovery are suggested based on profile stratification: airperson flight class, tactical military, and aerobatic pilots. This provides an approach to inform aeromedical decision making.CONCLUSION: Aviation medical examiners should remain cognizant of the clinically apparent and occult manifestations of cardiovascular dysfunction associated with COVID-19 infection when applying return-to-work screening guidelines. This will ensure high flight safety standards are maintained and sudden incapacitation risk mitigated during and following the ongoing pandemic.Elkhatib W, Herrigel D, Harrison M, Flipse T, Speicher L. Cardiovascular concerns from COVID-19 in pilots. Aerosp Med Hum Perform. 2022; 93(12):855-865.

Sports, Myocarditis and COVID-19: Diagnostics, Prevention and Return-to-Play Strategies

Myocarditis is an umbrella term for non-ischemic myocardial inflammation and remains a leading cause of sudden cardiac death in active individuals and athletes. Accurate diagnosing is challenging and diseases could often remain undetected. In the majority of cases, acute myocarditis resolves favourably. However, a relevant proportion of patients may have an increased risk of prognostically relevant cardiac arrhythmias and/or the development and progression of maladaptive myocardial remodelling (dilated cardiomyopathy). This review provides current knowledge on myocarditis and sports with special regard to the COVID-19 pandemic. Possible causes, common symptoms and proposed diagnostics are summarized. The relevance of temporary avoidance of intensive sports activities for both the prevention and therapy of acute myocarditis is discussed. Risk stratification, specific return-to-play recommendations and proposed follow-up diagnostics (also after COVID-19 infection) are presented.

Performance of Professional Soccer Players before and after COVID-19 Infection; Observational Study with an Emphasis on Graduated Return to Play

The impact of the COVID-19 pandemic in sport has been the subject of numerous studies over the past two years. However, knowledge about the direct impact of COVID-19 infection on the performance of athletes is limited, and the importance of studies on this topic is crucial during the current pandemic era. This study aimed to evaluate the changes in the match running performance (MRP) of professional soccer players that occurred as a result of COVID-19 infection after fulfilling all of the prerequisites for a safe return to play (RTP). The participants were 47 professional soccer players from a team which competed in first Croatian division (21.6 years old on average) during the 2020/21 season. The total sample was divided into two subgroups based on the results of a PCR test for COVID-19, where 31 players tested positive (infected) and 16 tested negative. We observed the PCR test results (positive vs. negative PCR), the number of days needed to return to the team, number of days needed to RTP after quarantine and isolation, and MRP (10 variables measured by a global positioning system). The number of days where the infected players were not included in the team ranged from 7 to 51 (Median: 12). Significant pre- to post-COVID differences in MRP for infected players were only found for high-intensity accelerations and high-intensity decelerations (t-test = 2.11 and 2.13, respectively; p < 0.05, moderate effect size differences), with poorer performance in the post-COVID period. Since a decrease of the MRP as a result of COVID-19 infection was only noted in two variables, we can highlight appropriateness of the applied RTP. However, further adaptations and improvements of the RTP are needed with regard to high-intensity activities.