Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement

Dermot Phelan*, Jonathan H. Kim, Michael D. Elliott, Meagan M. Wasfy, Paul Cremer, Amer M. Johri, Michael S. Emery, Partho P. Sengupta, Sanjay Sharma, Matthew W. Martinez, Andre La Gerche

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

104 Scopus citations

Abstract

As our understanding of the complications of coronavirus disease-2019 (COVID-19) evolve, subclinical cardiac pathology such as myocarditis, pericarditis, and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern. The potential implications of these findings in athletes are significant given the concern that exercise, during the acute phase of viral myocarditis, may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias. Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID-19 in order to permit safe return to play. Cardiac imaging is at the center of these evaluations. This review seeks to evaluate the current evidence regarding COVID-19–associated cardiovascular disease and how multimodality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection. Guidance is provided with diagnostic “red flags” that raise the suspicion of pathology. Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from subclinical cardiac disease. The strengths and limitations of different imaging modalities are discussed and an approach to return to play decision making for athletes post–COVID-19, as informed by multimodality imaging, is provided.

Original languageEnglish (US)
Pages (from-to)2635-2652
Number of pages18
JournalJACC: Cardiovascular Imaging
Volume13
Issue number12
DOIs
StatePublished - Dec 2020

Keywords

  • athlete
  • COVID-19
  • multimodality imaging
  • myocardial injury
  • myocarditis
  • return to play

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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