Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sports

Juliette C van Hattum; Joëlle J N Daems; Sjoerd M Verwijs; Leonoor V Wismans; Maarten A van Diepen; Maarten Groenink; S Matthijs Boekholdt; R Nils Planken; Adrienne van Randen; Alexander Hirsch; Maarten H Moen; Yigal M Pinto; Arthur A M Wilde; Harald T Jørstad

doi:10.1136/heartjnl-2023-323058

Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sports

Juliette C van Hattum
, Joëlle J N Daems
, Sjoerd M Verwijs
, Leonoor V Wismans
, Maarten A van Diepen
, Maarten Groenink
, S Matthijs Boekholdt
, R Nils Planken
, Adrienne van Randen
, Alexander Hirsch
, Maarten H Moen
, Yigal M Pinto
, Arthur A M Wilde
, Harald T Jørstad

Amsterdam UMC, Locatie VUmc
Dutch National Olympic Committee & National Sports Federation

Research output: Contribution to journal › Article › Academic › peer-review

4 Citations (Scopus)

50 Downloads (Pure)

Abstract

OBJECTIVE:

Longitudinal consequences and potential interactions of COVID-19 and elite-level sports and exercise are unclear. Therefore, we determined the long-term detrimental cardiac effects of the interaction between SARS-CoV-2 infection and the highest level of sports and exercise.

METHODS:

This prospective controlled study included elite athletes from the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise cohort. Athletes infected with SARS-CoV-2were offered structured, additional cardiovascular screenings, including cardiovascular MRI (CMR). We compared ventricular volumes and function, late gadolinium enhancement (LGE) and T1 relaxation times, between infected and non-infected elite athletes, and collected follow-up data on cardiac adverse events, ventricular arrhythmia burden and the cessation of sports careers.

RESULTS:

We included 259 elite athletes (mean age 26±5 years; 40% women), of whom 123 were infected (9% cardiovascular symptoms) and 136 were controls. We found no differences in function and volumetric CMR parameters. Four infected athletes (3%) demonstrated LGE (one reversible), compared with none of the controls. During the 26.7 (±5.8) months follow-up, all four athletes resumed elite-level sports, without an increase in ventricular arrhythmias or adverse cardiac remodelling. None of the infected athletes reported new cardiac symptoms or events. The majority (n=118; 96%) still participated in elite-level sports; no sports careers were terminated due to SARS-CoV-2.

CONCLUSIONS:

This prospective study demonstrates the safety of resuming elite-level sports after SARS-CoV-2 infection. The medium-term risks associated with SARS-CoV-2 infection and elite-level sports appear low, as the resumption of elite sports did not lead to detrimental cardiac effects or increases in clinical events, even in the four elite athletes with SARS-CoV-2 associated myocardial involvement.

Original language	English
Pages (from-to)	254-262
Number of pages	9
Journal	Heart (British Cardiac Society)
Volume	110
Issue number	4
Early online date	7 Sept 2023
DOIs	https://doi.org/10.1136/heartjnl-2023-323058
Publication status	Published - 7 Sept 2023

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2024.

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10.1136/heartjnl-2023-323058

Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sportsFinal published version, 1.57 MBLicence: CC BY-NC

Cite this

van Hattum, J. C., Daems, J. J. N., Verwijs, S. M., Wismans, L. V., van Diepen, M. A., Groenink, M., Boekholdt, S. M., Planken, R. N., van Randen, A., Hirsch, A., Moen, M. H., Pinto, Y. M., Wilde, A. A. M., & Jørstad, H. T. (2023). Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sports. Heart (British Cardiac Society), 110(4), 254-262. https://doi.org/10.1136/heartjnl-2023-323058

@article{f171f56e13d64d868fc65bd71c797f05,

title = "Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sports",

abstract = "OBJECTIVE: Longitudinal consequences and potential interactions of COVID-19 and elite-level sports and exercise are unclear. Therefore, we determined the long-term detrimental cardiac effects of the interaction between SARS-CoV-2 infection and the highest level of sports and exercise.METHODS: This prospective controlled study included elite athletes from the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise cohort. Athletes infected with SARS-CoV-2were offered structured, additional cardiovascular screenings, including cardiovascular MRI (CMR). We compared ventricular volumes and function, late gadolinium enhancement (LGE) and T1 relaxation times, between infected and non-infected elite athletes, and collected follow-up data on cardiac adverse events, ventricular arrhythmia burden and the cessation of sports careers.RESULTS: We included 259 elite athletes (mean age 26±5 years; 40\% women), of whom 123 were infected (9\% cardiovascular symptoms) and 136 were controls. We found no differences in function and volumetric CMR parameters. Four infected athletes (3\%) demonstrated LGE (one reversible), compared with none of the controls. During the 26.7 (±5.8) months follow-up, all four athletes resumed elite-level sports, without an increase in ventricular arrhythmias or adverse cardiac remodelling. None of the infected athletes reported new cardiac symptoms or events. The majority (n=118; 96\%) still participated in elite-level sports; no sports careers were terminated due to SARS-CoV-2.CONCLUSIONS: This prospective study demonstrates the safety of resuming elite-level sports after SARS-CoV-2 infection. The medium-term risks associated with SARS-CoV-2 infection and elite-level sports appear low, as the resumption of elite sports did not lead to detrimental cardiac effects or increases in clinical events, even in the four elite athletes with SARS-CoV-2 associated myocardial involvement.",

author = "\{van Hattum\}, \{Juliette C\} and Daems, \{Jo{\"e}lle J N\} and Verwijs, \{Sjoerd M\} and Wismans, \{Leonoor V\} and \{van Diepen\}, \{Maarten A\} and Maarten Groenink and Boekholdt, \{S Matthijs\} and Planken, \{R Nils\} and \{van Randen\}, Adrienne and Alexander Hirsch and Moen, \{Maarten H\} and Pinto, \{Yigal M\} and Wilde, \{Arthur A M\} and J{\o}rstad, \{Harald T\}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2024.",

year = "2023",

month = sep,

day = "7",

doi = "10.1136/heartjnl-2023-323058",

language = "English",

volume = "110",

pages = "254--262",

journal = "Heart (British Cardiac Society)",

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publisher = "BMJ Publishing Group",

number = "4",

}

van Hattum, JC, Daems, JJN, Verwijs, SM, Wismans, LV, van Diepen, MA, Groenink, M, Boekholdt, SM, Planken, RN, van Randen, A, Hirsch, A, Moen, MH, Pinto, YM, Wilde, AAM & Jørstad, HT 2023, 'Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sports', Heart (British Cardiac Society), vol. 110, no. 4, pp. 254-262. https://doi.org/10.1136/heartjnl-2023-323058

TY - JOUR

T1 - Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sports

AU - van Hattum, Juliette C

AU - Daems, Joëlle J N

AU - Verwijs, Sjoerd M

AU - Wismans, Leonoor V

AU - van Diepen, Maarten A

AU - Groenink, Maarten

AU - Boekholdt, S Matthijs

AU - Planken, R Nils

AU - van Randen, Adrienne

AU - Hirsch, Alexander

AU - Moen, Maarten H

AU - Pinto, Yigal M

AU - Wilde, Arthur A M

AU - Jørstad, Harald T

PY - 2023/9/7

Y1 - 2023/9/7

N2 - OBJECTIVE: Longitudinal consequences and potential interactions of COVID-19 and elite-level sports and exercise are unclear. Therefore, we determined the long-term detrimental cardiac effects of the interaction between SARS-CoV-2 infection and the highest level of sports and exercise.METHODS: This prospective controlled study included elite athletes from the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise cohort. Athletes infected with SARS-CoV-2were offered structured, additional cardiovascular screenings, including cardiovascular MRI (CMR). We compared ventricular volumes and function, late gadolinium enhancement (LGE) and T1 relaxation times, between infected and non-infected elite athletes, and collected follow-up data on cardiac adverse events, ventricular arrhythmia burden and the cessation of sports careers.RESULTS: We included 259 elite athletes (mean age 26±5 years; 40% women), of whom 123 were infected (9% cardiovascular symptoms) and 136 were controls. We found no differences in function and volumetric CMR parameters. Four infected athletes (3%) demonstrated LGE (one reversible), compared with none of the controls. During the 26.7 (±5.8) months follow-up, all four athletes resumed elite-level sports, without an increase in ventricular arrhythmias or adverse cardiac remodelling. None of the infected athletes reported new cardiac symptoms or events. The majority (n=118; 96%) still participated in elite-level sports; no sports careers were terminated due to SARS-CoV-2.CONCLUSIONS: This prospective study demonstrates the safety of resuming elite-level sports after SARS-CoV-2 infection. The medium-term risks associated with SARS-CoV-2 infection and elite-level sports appear low, as the resumption of elite sports did not lead to detrimental cardiac effects or increases in clinical events, even in the four elite athletes with SARS-CoV-2 associated myocardial involvement.

AB - OBJECTIVE: Longitudinal consequences and potential interactions of COVID-19 and elite-level sports and exercise are unclear. Therefore, we determined the long-term detrimental cardiac effects of the interaction between SARS-CoV-2 infection and the highest level of sports and exercise.METHODS: This prospective controlled study included elite athletes from the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise cohort. Athletes infected with SARS-CoV-2were offered structured, additional cardiovascular screenings, including cardiovascular MRI (CMR). We compared ventricular volumes and function, late gadolinium enhancement (LGE) and T1 relaxation times, between infected and non-infected elite athletes, and collected follow-up data on cardiac adverse events, ventricular arrhythmia burden and the cessation of sports careers.RESULTS: We included 259 elite athletes (mean age 26±5 years; 40% women), of whom 123 were infected (9% cardiovascular symptoms) and 136 were controls. We found no differences in function and volumetric CMR parameters. Four infected athletes (3%) demonstrated LGE (one reversible), compared with none of the controls. During the 26.7 (±5.8) months follow-up, all four athletes resumed elite-level sports, without an increase in ventricular arrhythmias or adverse cardiac remodelling. None of the infected athletes reported new cardiac symptoms or events. The majority (n=118; 96%) still participated in elite-level sports; no sports careers were terminated due to SARS-CoV-2.CONCLUSIONS: This prospective study demonstrates the safety of resuming elite-level sports after SARS-CoV-2 infection. The medium-term risks associated with SARS-CoV-2 infection and elite-level sports appear low, as the resumption of elite sports did not lead to detrimental cardiac effects or increases in clinical events, even in the four elite athletes with SARS-CoV-2 associated myocardial involvement.

UR - https://www.scopus.com/pages/publications/85183947558

U2 - 10.1136/heartjnl-2023-323058

DO - 10.1136/heartjnl-2023-323058

M3 - Article

C2 - 37678891

SN - 1355-6037

VL - 110

SP - 254

EP - 262

JO - Heart (British Cardiac Society)

JF - Heart (British Cardiac Society)

IS - 4

ER -

Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sports

Abstract

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