Myocarditis prevalence is low in student athletes after mild-moderate COVID-19

  • Starekova J & al.
  • JAMA Cardiol
  • 14 Jan 2021

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In student athletes who had COVID-19 with no or mild-moderate symptoms and normal serum values, cardiac MRI (CMRI) may offer limited screening utility.
  • In this study, the prevalence of myocarditis in this population was 1.4%.

Why this matters

  • Editorial: high cost and poor diagnostic yield suggest low utility of CMRI, and clinicians should use pretest probability of myocarditis as a factor in deciding to screen.

Key results

  • Included 145 athletes, 37 female, age range 17-23 years.
  • 81.4% had symptoms (49.0% mild, 27.6% moderate).
  • 16.6% were asymptomatic (the rest were not documented).
  • None had severe symptoms or chest radiography.
  • CMRIs done a median of 15 (range, 11-194) days after positive COVID-19 test.
  • 2 patients, or 1.4% (95% CI, 0.4%-4.9%), had abnormal findings.
    • 1 was asymptomatic for COVID-19 but had “marked findings” of myopericarditis, improved at 1-month reevaluation.
    • 1 had mild signal abnormalities after mild-moderate COVID-19 symptoms; abnormalities were resolved at 1 month.
  • 26.2% had small nonspecific foci that did not meet criteria for myocarditis and are associated with athletic training.
  • 2 had increased troponin I levels that stayed repeatedly elevated but no indicators of myocarditis.

Study design

  • Case series, electronic health record data, University of Wisconsin, January 1-November 29, 2020.
  • Funding: Not disclosed.

Limitations

  • Retrospective, selected population of trained competitive athletes.
  • Late CMRI, troponin testing could have missed earlier mild myocardial injury.