Study of Big Ten college athletes suggests higher risk for post-COVID-19 heart problems
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May 27, 2021, 3:39 PM
7 min read
Share to FacebookShare to TwitterEmail this articleA study out Thursday on the risk of heart damage to college athletes who have had COVID-19 contradicts other recent studies by suggesting symptoms are not the best indicator for possible heart problems and advocating for continued high-level cardiac monitoring, awareness and possible testing of athletes post-COVID.
The study published in JAMA Cardiology found the inflammatory heart condition myocarditis in 37, or 2.3%, of 1,597 Big Ten college athletes given a cardiac MRI after testing positive for COVID-19.
Nine of those athletes with myocarditis reported cardiac symptoms, but 28 reported no cardiac symptoms.
"Unfortunately, from our study we show that symptoms do not help us very much," said cardiologist Dr. Lawrence Rink, who has been a team doctor at Indiana University for 40 years. "I won't say symptoms are of no value. But they did not pick up the majority of our cases of what we were calling myocarditis."
That interpretation contradicts two prior studies, one of professional athletes in March and another of college athletes in April, which determined cardiopulmonary and COVID-19 symptoms to be good predictors of possible post-COVID-19 heart-related issues.
Doctors from those earlier studies suggested that teams could possibly lessen some of the intense testing -- including cardiac MRIs -- and restrictions from activity that athletes had been undergoing since last fall. That's when early, small-scale studies showed much higher rates of myocarditis among athletes who had contracted COVID-19, including about 15% in one study of about two dozen Ohio State athletes.
Ohio State cardiologist Dr. Curt Daniels, who led that study, is also an author of the study released Thursday, which he said is the first to show -- on a wider scale -- that people who get COVID-19 and don't have symptoms can still have changes with their heart. He said it's more an issue of awareness and of the need for further, long-term analysis, including follow-up MRIs to see whether the inflammation resolves over time.
"Dr. Rink and I both aren't saying everyone needs an MRI who has had COVID," Daniels said. "The findings show you can't rely just on symptoms to say, 'Hey, you're fine. Go do everything on Day 11 coming out of isolation.' You need to take it slow, watch out for potential symptoms and if there are any, seek medical care and further evaluation."
Cardiac MRIs are considered a premier diagnostic tool for detecting heart problems, but they are expensive and time-consuming and require special equipment and expertise not available in every college town. They're usually given after or in conjunction with an electrocardiogram, a troponin protein blood test and a heart ultrasound. At many schools, an abnormal finding on any of those tests would be assessed, along with symptoms, to determine whether a cardiac MRI is needed.
The Big Ten study stated that when cardiac MRIs were done for post-COVID-19 athletes, regardless of symptoms, they "yielded a 7.4-fold increase in detection of myocarditis."
Doctors who were involved in the nationwide study of college athletes released in April in the American Heart Association journal Circulation had said athletes who had only mild or no symptoms might not need any cardiac testing because their overall data showed such a low prevalence of myocarditis. They noted most of those cases involved an athlete who showed symptoms such as fever, body aches or cardiopulmonary distress.
That nationwide study reported heart issues in 21 -- or 0.7% -- of 3,018 college athletes who had tested positive for COVID-19 and had a cardiac evaluation. Of those 21 athletes, 16 had either cardiopulmonary or mild to moderate COVID-19 symptoms.
Daniels said the main difference between that nationwide study and the Big Ten study was that the Big Ten study was based on a larger pool of athletes who had cardiac MRIs regardless of symptoms or other tests' results.
In the nationwide study, most of the 3,018 athletes did not have cardiac MRIs. About 11% -- or 317 -- did. The 21 athletes with signs of heart issues came from that smaller pool who received MRIs, where they made up about 6.6%.
"When they used the diagnosis of myocarditis, they were using it based on cardiac MRI," Rink said. If a study only has a small percent of athletes getting MRIs, he said, "how do you really know what percent had myocarditis?"
