Is coronavirus affecting the hearts of college athletes?
By Gretchen Reynolds
In a new study of 26 college athletes who tested positive for the coronavirus, four later showed signs of inflammation in their heart muscles. The study, published in JAMA Cardiology, was small and limited but tees up the issue of whether COVID-19, although primarily a respiratory disease, might also affect the hearts of infected people, even if they are young, strapping and otherwise healthy.
As most of us are aware, many aspects of the novel coronavirus and its pathological impacts remain uncertain, even now, more than six months into the pandemic. It’s thought that the virus enters the body primarily through the nose, where it replicates and spreads down the respiratory tract and to the lungs. But it can also affect other parts of the body, including the gastrointestinal tract, blood vessels, kidneys and even the brain.
The heart is not impervious, either. For a well-publicized study published in July in JAMA Cardiology, German researchers scanned the hearts of 100 middle-aged men and women who had developed moderate or severe COVID-19 illness and found “cardiac involvement” among 78% of them. Compared with the hearts of healthy people in a control group, their cardiac muscles showed inflammation or high levels of substances that indicate tissue damage.
Concerns about COVID-19 and the heart have become widespread enough that the American College of Cardiology’s Sports & Exercise Cardiology Council released a consensus statement in May advising healthy athletes who develop COVID-19 to rest for at least two weeks after their first symptoms and consult with a physician if they notice subsequent worrying symptoms, such as chest pain or shortness of breath.
But the worry about COVID-19 and athletes’ hearts relied on conjecture, since, at that point, scientists had not examined the hearts of infected athletes, to see if there might be hints of viral involvement there.
So, for the new study, physicians and researchers at the Ohio State University decided to scan the hearts of collegiate athletes who had tested positive for the virus. The scientists, most of them cardiologists, are affiliated with a sports medicine clinic at the university that treats and clears athletes after injuries and medical concerns.
So far this year, 26 male and female college athletes, representing sports including football and track, had been referred to the clinic after testing positive for the coronavirus. None had developed serious illness. In fact, most had been asymptomatic and, after isolating themselves for several weeks, reported feeling fine when they showed up at the clinic.
To see if this exuberant vigor extended to their cardiac systems, the scientists scanned each athlete’s heart, using magnetic resonance imaging, which can pick up subtle signs of inflammation, scarring and other heart problems, said Dr. Saurabh Rajpal, an assistant professor of cardiology at the Ohio State University Wexner Medical Center and the lead author of the new study.
Afterward, the researchers analyzed the scans and, using widely accepted diagnostic criteria, concluded that four of the young athletes, representing 15% of the group, displayed symptoms of myocarditis, which is an inflammation of the heart muscle known, occasionally, to be triggered by viral infections. In severe cases, myocarditis causes permanent heart damage, but it also may resolve without lingering problems.
The four athletes were men, and two had experienced mild symptoms during their coronavirus infection; the other two had been asymptomatic. None reported any symptoms of cardiac concerns.
The hearts of another eight of the athletes, mostly men, contained slight signs of scarring or other abnormalities, Rajpal said.
It is “impossible to know,” though, whether the athletes’ COVID infections caused any of these seeming cardiac glitches, he points out, since the researchers did not have baseline heart scans from before their illnesses.
There are other reasons, too, to be cautious about linking coronavirus infections to any possible issues on the athletes’ heart scans, said Dr. Aaron Baggish, a sports cardiologist at Harvard University, director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center and medical director for the Boston Marathon, who has extensively researched athletes’ hearts. He was not involved with the new study, but familiar with it.
Competitive athletes’ hearts tend to look and function differently than the hearts of other people, Baggish said. So, these athletes’ hearts may be perfectly normal for competitors in their sports, apparent blips and all. To know if the coronavirus may somehow have affected their cardiac muscles, the athletes’ heart scans would need to be compared with those of a control group of uninfected collegiate athletes. The current study did not include a control group.
Baggish is starting a national registry of cardiac issues among collegiate athletes that may be related to COVID infections, he said. The registry will be housed at Harvard and cover Division I athletes nationwide. The resulting data should help researchers and clinicians to better understand whether and how COVID infections affect athletes’ hearts, he said.
In the meantime, Rajpal said that anyone who has tested positive for the coronavirus, including athletes, should be aware of the possibility, however slight, of cardiac involvement. Most people will be able to return to exercise and sports after several weeks of rest (and isolation, of course) without any problems, he said. But if you notice symptoms of potential heart involvement, such as chest pain or shortness of breath, obviously, consult a doctor.