Registries could offer insight into COVID-19's impact on college athletes' hearts

Researchers are soon expected to release initial findings from a national cardiac registry of NCAA athletes who have tested positive for COVID-19, giving hope to health care professionals trying to better understand the impact of the disease on the heart.

The data could help doctors diagnose and treat athletes recovering from COVID-19 who have developed myocarditis, an inflammation of the heart. While the number of such cases known publicly among athletes is low, the American College of Cardiology's Sports and Exercise Cardiology Leadership Council has outlined recommendations for when athletes who have tested positive for the coronavirus can resume physical activity. Guidelines include cardiac testing for those who had COVID-19 symptoms.

Sports medicine and cardiology experts at Harvard University and the University of Washington formed the national registry in collaboration with the American Medical Society for Sports Medicine and the American Heart Association to track cases of COVID-19 and its heart-related aftermath in NCAA athletes. More than 60 schools are currently contributing to the registry, called the Outcomes Registry for Cardiac Conditions in Athletes, or ORCCA.

Before COVID-19, myocarditis accounted for 7% to 20% of deaths attributed to sudden cardiac events in young athletes, according to a recent study in the journal JACC: Cardiovascular Imaging. But data on heart injury in athletes recovering from COVID-19 is limited.

"Registry data of cardiac testing and outcomes in athletes after COVID-19 are needed to guide future screening strategies," the study authors said.

The research database already has collected data from more than 3,000 athletes. It initially will focus on athletes who have been diagnosed with COVID-19 to identify how the condition impacts the cardiovascular system and injures the heart muscle, an AMSSM statement said. The long-term objective is a registry for athletes diagnosed with cardiovascular disease, regardless of whether it was related to COVID-19.

"You wouldn't want someone working out intensely in the middle of an inflammation of the heart because it could weaken the heart in the long term," said Dr. Rachel Lampert, a cardiologist with Yale Medicine in New Haven, Connecticut. She is on the steering committee for the registry. "That's why the question is particularly relevant in athletes."

According to a small study published in September in JAMA Cardiology, 4 out of 26 athletes (15%) from Ohio State University who had been diagnosed with COVID-19 and underwent heart MRIs had results "suggestive of myocarditis."

Ohio State, which lost to the University of Alabama in Monday's college football championship, is among the 14 schools in the Big Ten Conference. The conference has its own cardiac registry and is contributing to ORCCA.

Dr. Eugene H. Chung is an electrophysiologist and sports cardiologist at Michigan Medicine and member of the Big Ten Cardiac Registry Steering Committee. "It would be very interesting to get a sense of how often we're seeing myocarditis in student-athletes infected with COVID-19 – we don't quite know that yet," said Chung, who also is chair of ACC's Sports and Exercise Cardiology Leadership Council.

The Big Ten plans to separately review its registry data and have specialists not involved in the initial data collection report independently on findings from cardiovascular evaluations. The Big Ten registry also will include control groups of athletes not affected by COVID-19 and those suffering from other illnesses such as the flu to compare cardiac risk among all three groups.

"With the cardiac registry, the Big Ten will take the lead to further our understanding of the athletic heart as well as the course of COVID-19 infection in the collegiate student-athlete population," Chung and fellow conference registry steering committee members wrote in a recent article in the AHA journal Circulation.

"Our findings will be informative for broader public health policy as we fight coronavirus and all strive for safe return to play."

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