Raghav T Bhatia , Aneil Malhotra, Hamish MacLachlan, Sabiha Gati, Sarandeep Marwaha, Nikhil Chatrath, Saad Fyyaz, Haroldo Aleixo, Samar Al-Turaihi, Aswin Babu, Joyee Basu, Paul Catterson, Robert Cooper, Joelle J N Daems, Harshil Dhutia, Filipe Ferrari, Juliette C van Hattum, Zafar Iqbal, Alexandros Kasiakogias, Antoinette Kenny, Tamim Khanbhai, Shafik Khoury, Chris Miles, David Oxborough, Kashif Quazi, Dhrubo Rakhit, Anushka Sharma, Amanda Varnava, Maria Teresa Tome Esteban, Gherardo Finocchiaro, Ricardo Stein, Harald T Jorstad, Michael Papadakis, Sanjay Sharma. Heart (British Cardiac Society). 2023 Mar 27. Read the paper here.
Background and aim: The efficacy of pre-COVID-19 and post-COVID-19 infection 12-lead ECGs for identifying athletes with myopericarditis has never been reported. We aimed to assess the prevalence and significance of de-novo ECG changes following COVID-19 infection.
Methods: In this multicentre observational study, between March 2020 and May 2022, we evaluated consecutive athletes with COVID-19 infection. Athletes exhibiting de-novo ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all players (n=30) following COVID-19 infection, despite the absence of cardiac symptoms or de-novo ECG changes.
Results: 511 soccer players (median age 21 years, IQR 18-26 years) were included. 17 (3%) athletes demonstrated de-novo ECG changes, which included reduction in T-wave amplitude in the inferior and lateral leads (n=5), inferior leads (n=4) and lateral leads (n=4); inferior T-wave inversion (n=7); and ST-segment depression (n=2). 15 (88%) athletes with de-novo ECG changes revealed evidence of inflammatory cardiac sequelae. All 30 athletes who underwent a mandatory CMR scan had normal findings. Athletes revealing de-novo ECG changes had a higher prevalence of cardiac symptoms (71% vs 12%, p<0.0001) and longer median symptom duration (5 days, IQR 3-10) compared with athletes without de-novo ECG changes (2 days, IQR 1-3, p<0.001). Among athletes without cardiac symptoms, the additional yield of de-novo ECG changes to detect cardiac inflammation was 20%.
Conclusions: 3% of athletes demonstrated de-novo ECG changes post COVID-19 infection, of which 88% were diagnosed with cardiac inflammation. Most affected athletes exhibited cardiac symptoms; however, de-novo ECG changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.