Findings From Cardiovascular Evaluation of National Collegiate Athletic Association Division I Collegiate Student-Athletes After Asymptomatic or Mildly Symptomatic SARS-CoV-2 Infection
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Abstract
The risk of myocardial damage after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been controversial. The purpose of this study is to report the incidence of abnormal cardiovascular findings in National Collegiate Athletic Association (NCAA) Division I student-athletes with a history of SARS-CoV-2 infection.
Design:
This is a case series of student-athletes with SARS-CoV-2 infection and their subsequent cardiac work-up, including troponin level, electrocardiogram, and echocardiogram. Additional testing was ordered as clinically indicated.
Setting:
This study was conducted at a single NCAA Division I institution.
Participants:
Student-athletes were included if they tested positive for SARS-CoV-2 by PCR or antibody testing [immunoglobulin G (IgG)] from April 15, 2020 to October 31, 2020.
Intervention:
Cardiac testing was conducted as part of postinfection screening.
Main Outcome Measures:
This study was designed to quantify abnormal cardiovascular screening results and cardiac diagnoses after SARS-CoV-2 infection in Division I collegiate athletes.
Results:
Fifty-five student-athletes tested positive for SARS-CoV-2. Of these, 14 (26%) had a positive IgG and 41 (74%) had a positive PCR test. Eight abnormal cardiovascular screening evaluations necessitated further testing including cardiac magnetic resonance imaging (cMRI). Two athletes received new cardiac diagnoses, one probable early cardiomyopathy and one pericarditis, whereas the remaining 6 had normal cMRIs.
Conclusions:
These data support recent publications which recommend the de-escalation of cardiovascular testing such as cardiac MRI or echocardiogram for athletes who have recovered from asymptomatic or mildly symptomatic SARS-CoV-2 infection. Continued follow-up of these athletes for sequelae of SARS-CoV-2 is critical.
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SciScore for 10.1101/2021.01.07.21249407: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Upon arrival to campus, all student-athletes underwent serum immunoglobulin G (IgG) antibody (EuroImmun ELISA)[16] and nasopharyngeal or mid-turbinate testing via PCR (Hologic Panther Fusion)[17] for detection of SARS-CoV-2. IgGsuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing …SciScore for 10.1101/2021.01.07.21249407: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Upon arrival to campus, all student-athletes underwent serum immunoglobulin G (IgG) antibody (EuroImmun ELISA)[16] and nasopharyngeal or mid-turbinate testing via PCR (Hologic Panther Fusion)[17] for detection of SARS-CoV-2. IgGsuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:In the absence of baseline imaging, overreading imaging studies by a team experienced in sports cardiology may help avoid unnecessary investigation or exclusion from training.[27] Limitations: Despite being the largest published cohort to date of collegiate student-athletes undergoing post-COVID-19 cardiac screening, our study is still relatively small with limited follow up. Ambulatory rhythm monitoring is recommended in several expert consensus statements, but was not a standard part of our protocol and to our knowledge there is insufficient published data available supporting its routine use in post-COVID-19 cardiac screening. No athlete within our cohort experienced severe COVID-19 symptoms or required hospitalization. The vast majority of student-athletes had previous cardiovascular diagnostics, including 52/55 with a prior ECG and 20/55 with a prior resting echocardiogram available for direct comparison, which helped in interpreting borderline and abnormal findings. The three cases without prior ECGs were first-year student-athletes who had tested positive at home prior to matriculation and had not yet had their pre-participation exam. This cardiovascular screening occurred at a resource-rich institution with an established pre-participation program, and thus these findings may not be practical or representative for all young athletes.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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SciScore for 10.1101/2021.01.07.21249407: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Ethics approval The study design was reviewed by the Institutional Review Board of Stanford University and determined to be IRB exempt from full review. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Upon arrival to campus, all student-athletes underwent serum immunoglobulin G (IgG) antibody (EuroImmun ELISA)[16] and nasopharyngeal or mid-turbinate testing via PCR (Hologic Panther Fusion)[17] for detection of SARS-CoV-2. …IgGsuggested: NoneSciScore for 10.1101/2021.01.07.21249407: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Ethics approval The study design was reviewed by the Institutional Review Board of Stanford University and determined to be IRB exempt from full review. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Upon arrival to campus, all student-athletes underwent serum immunoglobulin G (IgG) antibody (EuroImmun ELISA)[16] and nasopharyngeal or mid-turbinate testing via PCR (Hologic Panther Fusion)[17] for detection of SARS-CoV-2. IgGsuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
In the absence of baseline imaging, overreading imaging studies by a team experienced in sports cardiology may help avoid unnecessary investigation or exclusion from training.[27] Limitations Despite being the largest published cohort to date of collegiate student-athletes undergoing post-COVID-19 cardiac screening, our study is still relatively small with limited follow up. Ambulatory rhythm monitoring is recommended in several expert consensus statements, but was not a standard part of our protocol and to our knowledge there is insufficient published data available supporting its routine use in post-COVID-19 cardiac screening. No athlete within our cohort experienced severe COVID-19 symptoms or required hospitalization. The vast majority of student-athletes had previous cardiovascular diagnostics, including 52/55 with a prior ECG and 20/55 with a prior resting echocardiogram available for direct comparison, which helped in interpreting borderline and abnormal findings. The three cases without prior ECGs were firstyear student-athletes who had tested positive at home prior to matriculation and had not yet had their pre-participation exam. This cardiovascular screening occurred at a resource-rich institution with an established pre-participation program, and thus these findings may not be practical or representative for all young athletes.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
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