PT  - JOURNAL ARTICLE
AU  - Juliette C van Hattum
AU  - Jessica L Spies
AU  - Sjoerd M Verwijs
AU  - Germaine C Verwoert
AU  - R Nils Planken
AU  - S Matthijs Boekholdt
AU  - Maarten Groenink
AU  - Arjan Malekzadeh
AU  - Yigal M Pinto
AU  - Arthur A M Wilde
AU  - Harald T Jorstad
TI  - Cardiac abnormalities in athletes after SARS-CoV-2 infection: a systematic review
AID  - 10.1136/bmjsem-2021-001164
DP  - 2021 Oct 01
TA  - BMJ Open Sport & Exercise Medicine
PG  - e001164
VI  - 7
IP  - 4
4099  - http://bmjopensem.bmj.com/content/7/4/e001164.short
4100  - http://bmjopensem.bmj.com/content/7/4/e001164.full
SO  - BMJ OPEN SP EX MED2021 Oct 01; 7
AB  - Objectives Quantification of pericardial/myocardial involvement and risks of sudden cardiac arrest/sudden cardiac death (SCA/SCD) after SARS-CoV-2 infection in athletes who return to sports.Design Systematic review on post-SARS-CoV-2 infection pericardial/myocardial manifestations in athletes.Data sources Combinations of key terms in Medline, Embase and Scopus (through 2 June 2021).Eligibility criteria for selecting studies Inclusion: athletes, with cardiovascular magnetic resonance (CMR) or echocardiography after recovery from SARS-CoV-2 infection, including arrhythmia outcomes. Exclusion: study population ≥1 individual comorbidity and mean age <18 or >64 years. Quality assessment was performed using Joanna Briggs Institute Critical Appraisal tools checklists.Results In total, 12 manuscripts (1650 papers reviewed) comprising 3131 athletes (2198 college/student athletes, 879 professional athletes and 54 elite athletes) were included. The prevalence of myocarditis on echocardiography and/or CMR was 0%–15%, pericardial effusion 0%–58% and late gadolinium enhancement (LGE) 0%–46%. Weighted means of diagnosed myocarditis were 2.1% in college/student athletes and 0% in elite athletes. The prevalence of LGE was markedly lower in studies with high-quality assessment scores (3%–4%) versus low scores (38%–42%). A single study reported reversibility of myocardial involvement in 40.7%. No important arrhythmias were reported. Ten studies (n=4171) reporting postrecovery troponin T/I found no clear relationship with cardiac abnormalities.Summary/conclusion Athletes have an overall low risk of SARS-CoV-2 pericardial/myocardial involvement, arrhythmias and SCA/SCD. Rates of pericardial/myocardial abnormalities in athletes are highly variable and dependent on study quality. Troponin screenings seem unreliable to identify athletes at risk for myocardial involvement. Prospective athlete studies, with pre-SARS-CoV-2 imaging (CMR), including structured follow-up and arrhythmia monitoring, are urgently needed.