Partnering with Athletes to Assess Risk of COVID-Related Myocarditis

  1. Bradley Kay
  2. Attila Feher
  3. Samuel Reinhardt
  4. Jason Cuomo
  5. Stephanie Arlis-Mayor
  6. Matthew Lynch
  7. Kyle Johnson
  8. Phil Kemp
  9. Henry Wagner
  10. Tyler Welsh
  11. Jerome Lamy
  12. Dana Peters
  13. Hamid Mojibian
  14. Lawrence H. Young
  15. Rachel Lampert
  16. Robert McNamara
  17. Lauren A. Baldassarre
  18. Edward J. Miller
  19. Erica S. Spatz

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Abstract

Background

Myocarditis in athletes is a feared complication of SARS-CoV-2, yet guidelines for screening with cardiac magnetic resonance imaging are lacking. Further, stakeholder involvement in the research is rare.

Hypothesis

We sought to determine the rates of cardiac magnetic resonance imaging evidence of SARS-CoV-2 related myocarditis in student athletes. We hypothesized that rates of myocarditis were lower than initially reported and that including athletes on the research team would enhance participant satisfaction and scientific integrity.

Methods

Accordingly, when members of a hockey team were infected with SARS-CoV-2, we invited them and their team physicians to be part of the design of a study assessing the incidence of myocarditis. We performed cardiac magnetic resonance imaging on participating hockey players infected with SARS-CoV-2 and compared them to a healthy lacrosse cohort. Participants were given an optional survey to complete at the end of the study to assess their satisfaction with it.

Results

Four hockey players and two team physicians joined the study team; eight hockey players and four lacrosse players participated in the study. Zero athletes met imaging criteria for myocarditis; delayed enhancement was observed in seven cases and three controls. Athletes supported sharing the findings with the participants. No athletes reported feeling uncomfortable participating, knowing other athletes participated on the research team.

Conclusion

Rates of SARS-CoV-2 myocarditis in young athletes appears to be lower than initially reported. Partnered research is important, especially in populations with more to lose, such as collegiate athletes; future studies should include stakeholders in the study design and execution.

Key points

Cardiac MRI findings of myocarditis after COVID infection in young athletes is rare. Subjects of research studies appreciate involvement in the development of the study, and this also builds trust with the research team.

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  1. ScreenIT

    SciScore for 10.1101/2022.01.29.22270074: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The Yale Institutional Review Board approved of the study.
    Sex as a biological variableAll male hockey players known to be infected with COVID-19 and all male lacrosse players were contacted for participation via e-mail (Supplemental File 1).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis was performed using GraphPad Prism version 8, San Diego, CA.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results 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:
    Our study does have significant limitations. Most notable is the small sample size.. Many athletes had left campus on or around IRB approval of the study due to the holiday and did not return in time to fall within the pre-specified eight week window. Additionally, we do not know the perspectives or concerns of athletes who chose not to participate, though the primary reasons given by non-participants in the study was a lack of time.

    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: Please consider improving the rainbow (“jet”) colormap(s) used on page 14. At least one figure is not accessible to readers with colorblindness and/or is not true to the data, i.e. not perceptually uniform.

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.01.29.22270074v1 on medRxiv