Prevalence of abnormal cardiovascular magnetic resonance findings in athletes recovered from COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Background Athlete’s heart is characterised by structural and functional cardiac adaptations that stem from high level athletic training1. There is evidence showing that non-specific myocardial fibrosis as shown in cardiac magnetic resonance (CMR) studies is more frequently encountered in athletes compared to sedentary individuals2. With the spread of COVID-19 pandemic, concerns were raised as to whether athletes would be at increased risk of myocardial involvement and subsequent adverse events. This systematic review and meta-analysis aims to assess the prevalence of CMR derived myocardial tissue characterisation abnormalities in athletes with COVID-19 infection. Methods PubMed, Cochrane and Web of Science databases were systematically searched from inception to 15th of September 2022. The statistical analyses were conducted using the Stata software (StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC). Results We identified 476 articles out of which 12 studies with a total of 3,338 athletes were included in the meta-analysis 3–14. The median of the time period between the participants’ positive COVID test and their CMR scan ranged across the studies from 16 to 44 days. The pooled prevalence of LGE in athletes infected with COVID-19 was 5.85% (95% CI 2.17, 10.92, p <0.001) (figure 1). Publication bias by Egger’s linear regress test was not significant (p = 0.16). Two studies with a total of 292 athletes compared the presence of LGE between athletes with COVID-19 and healthy control athletes 4,6. This showed a statistically significant higher prevalence of LGE in athletes infected with COVID-19 (figure 2). Conclusion CMR has an important role in the evaluation of highly trained individuals. This meta-analysis demonstrates that COVID-19 infection is associated with high prevalence of LGE and abnormal T1/T2 values in highly trained athletes. Whether this remains in the longer-term and whether it might associate with adverse events remains to be seen and further case control studies are needed in order to understand the implications of COVID-19 infection in the risk assessment of athletes.