Prevalence and Outcome of Post COVID-19 Myocarditis in Professional Athletes

Abstract

Objectives: This study investigates the prevalence and outcomes of moderate to severe post-COVID-19 myocarditis diagnosed via cardiac magnetic resonance imaging (CMR) among elite athletes. Additionally, it explores the role of speckle tracking echocardiography in detecting and monitoring affected athletes. Methodology: Between April 1, 2022, and April 1, 2023, we clinically screened 360 post-COVID national team athletes, prospectively recruiting 64 athletes who experienced moderate or severe COVID-19 infection. All participants underwent electrocardiogram (ECG), 2D echocardiography, and CMR. Clinical follow-up, stress ECG, and 24-hour Holter ECG were conducted at 10 (9;14) months. Results: The prevalence of post-COVID-19 myocarditis among athletes with moderate or severe infection was 10.9%. Troponin levels were significantly elevated in myocarditis cases, while left ventricular global longitudinal strain (LVGLS) values were significantly reduced compared to non-myocarditis cases. LVGLS values showed significant improvement at 4 (3;4.4) months follow-up. CMR findings revealed significantly higher Global T1 and T2 relaxation times in positive cases (p<0.001), which decreased significantly over time (p<0.001). Late gadolinium enhancement and left ventricular ejection fraction remained stable. All athletes returned to play safely after a three-month clinical follow-up. Conclusion: Post-COVID myocarditis prevalence among athletes with moderate or severe infection is 10.9%. LVGLS is a promising screening tool for post-COVID-19 myocarditis.