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Cardiovascular complications and outcomes among athletes with COVID-19 disease: a systematic review
Bandar Alosaimi1,1, Isamme AlFayyad2, Salman Alshuaibi3
1Research Center, King Fahad Medical City, Riyadh, 11525, Saudi Arabia. balosaimi@kfmc.med.sa.
Insights
COVID-19 infection has a low prevalence of cardiovascular complications in athletes during short-term follow-up. Early cardiac assessment is crucial for safe return-to-play protocols in athletes post-COVID-19.
Area of Science:
- Sports Medicine
- Cardiology
- Infectious Diseases
Background:
- Emerging evidence on cardiovascular sequelae of COVID-19 necessitates further research for safe return-to-play guidelines.
- Athletes are a unique population requiring specific considerations regarding post-COVID-19 cardiovascular health.
Purpose of the Study:
- To systematically review the prevalence of cardiovascular complications in athletes following COVID-19 infection.
- To explore outcomes, diagnostic approaches, and safe return-to-play strategies for athletes post-COVID-19.
Main Methods:
- Systematic search of Medline, Cochrane Library, Ovid, Embase, and Scopus for quantitative studies on athletes post-COVID-19 infection.
- Inclusion of peer-reviewed studies reporting cardiovascular complications and outcomes in athletes; exclusion of non-athletic studies, editorials, and guidelines.
- Quality assessment using the Newcastle-Ottawa Scale.
Main Results:
- 15 articles with 6229 athletes included; 1023 were elite or professional.
- Prevalence: myocarditis (0.4%-15.4%), pericarditis (0.06%-2.2%), pericardial effusion (0.27%-58%).
- Elevated troponin levels reported in 0.9%-6.9% of athletes in five studies.
Conclusions:
- Low short-term prevalence of cardiovascular complications following COVID-19 infection in athletes.
- Early recognition and continuous cardiac assessment are vital for preventing complications and ensuring safe return-to-play.
- A stepwise evaluation approach, emphasizing imaging, is critical for diagnosis and risk assessment.
Background:
Current evidence still emerging regarding the risk of cardiovascular (CV) sequel associated with coronavirus disease 2019 (COVID-19) infection, and considerable replicated studies are needed to ensure safe return-to-play. Therefore, we aimed in this systematic review to measure the prevalence of CV complications suffered by COVID-19 athletic patients, explore the outcomes, optimal approaches to diagnoses, and safe return-to-play considerations.
Methods:
A systematic search on post COVID-19 infection quantitative studies among athletes was conducted following MeSH terms in Medline, Cochrane Library, Ovid, Embase and Scopus (through 15 January 2022). We included peer-reviewed studies reported athletes' CV complications and the outcomes post COVID-19 infection. Editorials, letters, commentaries, and clinical guidelines, as well as duplicate studies were excluded. Studies involving non-athletic patients were also excluded. Quality assessment was performed using Newcastle-Ottawa Scale.
Results:
We included 15 eligible articles with a total of 6229 athletes, of whom 1023 were elite or professional athletes. The prevalence of myocarditis ranged between 0.4% and 15.4%, pericarditis 0.06% and 2.2%, and pericardial effusion between 0.27% and 58%. Five studies reported elevated troponin levels (0.9-6.9%).
Conclusions:
This study provides a low prevalence of CV complications secondary to COVID-19 infection in short-term follow-up. Early recognition and continuous assessment of cardiac abnormality in competitive athletes are imperative to prevent cardiac complications. Establishing a stepwise evaluation approach is critical with an emphasis on imaging techniques for proper diagnosis and risk assessment for a safe return to play.
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