The extent and effects of prolonged symptoms in athletes following COVID-19 infection has been an area of clinical uncertainty. In a new study published in the British Journal of Sports Medicine, researchers reported that college athletes rarely experience persistent symptoms after COVID-19 infections. Also rare is chest pain upon return to exercise, but is nonetheless a concerning finding that may warrant further clinical workup.
The findings stem from data gathered through the Outcomes Registry for Cardiac Conditions in Athletes, a national research database established by the University of Washington School of Medicine and Massachusetts General Hospital. The initiative tracks COVID-19 cases in NCAA athletes in order to screen for, and better understand, cardiopulmonary-related impacts from those infections.
The observational study looked at 3,597 male and female athletes from 44 colleges and universities. All of the athletes had been infected by COVID-19, but just 1.2% were found to have persistent symptoms - defined as those lasting more than three weeks from initial illness or symptom onset. During return to exercise, the prevalence of exertional symptoms - including chest pain, shortness of breath, fatigue and heart palpitations - was also low, in just 4% of the study cohort.
"For the vast majority of athletes, this study shows that a return to play is possible without lingering COVID symptoms. But any new chest pain or cardiopulmonary symptom should be taken seriously," said Dr. Jonathan Drezner, director of the UW Medicine Center for Sports Cardiology and the study's senior author. "Even if initial cardiac testing is negative after a COVID-19 illness, chest pain while exerting yourself should be evaluated."
It has long been known that COVID-19 can injure the heart, including its membrane and muscle. With the latter, the virus can directly infect heart cells, leading to dangerous inflammation known as myocarditis. Results from the study support the use of cardiac MRI in athletes with exertional chest pain and increased clinical suspicion of cardiac involvement after COVID-19. Of the 24 athletes with exertional chest pain who underwent cardiac MRI, probable or definite COVID-19 involvement was found in five cases, or 20.8%. For athletes with exertional symptoms other than chest pain, there were no cases of probable or definite COVID-19 cardiac involvement detected by cardiac MRI.
"This is useful information as we continue to see so many athletes - collegiate or otherwise - returning to sports," said Dr. Aaron Baggish, director of Massachusetts General Hospital's Cardiovascular Performance Program and a study co-author. "While it's heartening to see that the risk for persistent COVID symptoms in these athletes is low, we should keep monitoring players and checking in with them on how they're feeling once they're back in action."
