ORIGINAL RESEARCH

Heart disease in young elite athletes having a history of COVID-19

Makarov LM1,2,3, Komolyatova VN1,2, Kiselyova II1, Besportochny DA1, Akopyan AG1, Dmitrieva AV1, Aksenova NV1
About authors

1 Federal Scientific and Clinical Center for Children and Adolescents of the Federal Medical Biological Agency, Moscow, Russia

2 Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia

3 Academy of Postgraduate Education, Federal Scientific and Clinical Center for Children and Adolescents of the Federal Medical Biological Agency, Moscow, Russia

Correspondence should be addressed: Leonid M. Makarov
Moskvorechye, 20, Moscow, 115409, Russia; ur.liam@vorakamdinoel.rd

About paper

Funding: the study was supported by grant № 37В/CSM FMBA Rossii/22 of 10.08.2022.

Author contribution: Makarov LM — study concept and design, manuscript writing, conclusions; Komolyatova VN — data analysis by statistical and mathematical methods, literature data acquisition; Kiselyova II — clinical assessment of athletes, literature data acquisition; Besportochny DA — instrumental assessment, working on graphics; Akopyan AG, Dmitrieva AV — instrumental assessment; Aksyonova NV — selection of populations for assessment.

Compliance with ethical standards: the study was approved by the Ethics Commitee of the Pirogov Russian National Research Medical University (protocol № 217 of 18 April 2022) and conducted in accordance with the framework legislation "On Protection of Public Health"; the informed consent to examination was submitted by all participants.

Received: 2023-07-27 Accepted: 2023-08-23 Published online: 2023-09-30
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The impact of coronavirus infection (SARS-CoV-2) on cardiac output in underage athletes is uncertain. The study was aimed to determine heart disease in young elite athletes having a history of COVID-19 (SARS-CoV-2). A retrospective analysis of the results of the developed three-phase medical assessment of 236 elite athletes aged 14–17 (16 ± 1), who had had SARS-CoV-2 infection, was performed. The first phase of assessment involved examination, ECG, ECHO, bicycle ergometry (BEM), creatine kinase and creatine kinase MB tests. During the second phase 22 athletes (9.3%) underwent a more thorough assessment that included Holter monitoring (HM) with heart rate turbulence (HRT), microvolt T–wave alternans (MTWA), heart rate variability (HRV) estimation, high-resolution ECG (HRECG), determination of myocardial damage biochemical markers (troponin, NТproBNP) due to alterations revealed. Seven athletes (32%) having alterations revealed during this phase were referred to gadolinium enhancement cardiac magnetic resonance imaging (MRI) (the third phase). Myopericarditis was diagnosed in four cases (1.7% of 236) based on the results. Thus, low (below 2%) myocardial involvement has been revealed in young elite athletes, who have a history of SARSCoV-2 infection. Cardiovascular assessment algorithm has been developed for such athletes. Detection of cardiac arrhythmias by ECG, BEM, and HM is the most informative. HRECG, HRV, HRT, and MTWA can be used as additional methods to determine indications for MRI as a gold standard of the diagnosis of myocarditis.

Keywords: coronavirus infection, SARS-CoV2, myocarditis, young elite athlete, noninvasive electrocardiology

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