Understanding the Link Between COVID-19 and Myocarditis in Competitive Athletes

Research on Myocarditis Prevalence in Athletes with COVID-19

Understanding Myocarditis

Myocarditis refers to the inflammation of the heart muscle. This condition can be challenging to detect due to its association with a diverse range of clinical symptoms. It is particularly prevalent among younger individuals, who are often not regarded as a high-risk demographic for cardiovascular issues. Effective treatment is crucial as it aids in preventing negative health outcomes linked to myocarditis, such as diminished ventricular function.

Causes of Myocarditis

Various factors can lead to the development of myocarditis, including infections, specific medications, and pre-existing health conditions. In the United States, viral infections are the predominant cause of myocarditis. Certain viruses are more frequently linked to this condition, with the immune system’s inflammatory response to these viruses sometimes contributing to myocarditis development.

Myocarditis and Competitive Athletes

Myocarditis is a significant cause of mortality among competitive athletes. While the exact reasons for this are not fully understood, some researchers suggest that intense physical exertion may heighten the risk of myocardial damage in athletes already diagnosed with myocarditis. Although regular exercise is known to bolster immune function, prolonged high-intensity workouts may lead to immunosuppression. Evidence indicates that elite endurance athletes may exhibit reduced T cell counts, which are vital for recognizing and combating infections. Consequently, competitive athletes might face a heightened risk of infections that could lead to myocarditis.

Investigating COVID-19’s Role

As COVID-19 is a newly emerged virus, researchers are exploring its potential link to myocarditis. Current evidence is insufficient to definitively establish this connection. However, the high incidence of COVID-19 in the United States underscores the necessity for further investigation into this topic.

Study on COVID-19 Myocarditis in Athletes

A recent study published in JAMA Cardiology examined the prevalence of myocarditis in competitive athletes who contracted COVID-19. The study involved 1,597 competitive athletes from 13 universities across the United States who tested positive for SARS-CoV-2 using polymerase chain reaction (PCR) methods. Participants completed surveys to identify potential symptoms of COVID-19 myocarditis and underwent various cardiac tests, including cardiac magnetic resonance (CMR) screening to aid in diagnosis.

Findings from the Study

The study identified 37 athletes diagnosed with myocarditis, comprising nine with clinical-stage myocarditis and 28 with subclinical myocarditis, representing 2.3% of the total participants. Notably, if diagnoses were based solely on survey responses without CMR screening, only about 0.31% would have been identified as having myocarditis. These findings suggest that CMR screening may be a vital tool for diagnosing this often asymptomatic condition, though further research is necessary to clarify the relationship between COVID-19 and myocarditis.

References

1. Al-Akchar, M., Kiel, J. (2021, May 12). Acute Myocarditis. StatPearls [Internet]. Accessed 2021, June 1, from https://www.ncbi.nlm.nih.gov/books/NBK441847/
2. Kang, M., An, J. (2021, May 10). Viral Myocarditis. StatPearls [Internet]. Accessed 2021, June 1, from https://www.ncbi.nlm.nih.gov/books/NBK459259/
3. Hurwitz, B., Issa, O. (2020, November 4). Management and Treatment of Myocarditis in Athletes. Curr Treat Options Cardiovasc Med 22(12): 65. Doi: 10.1007/s11936-020-00875-1.
4. Martin, S.A., Pence, B.D., Woods, J.A. (2009, October). Exercise and Respiratory Tract Viral Infections. Exerc Sport Sci Rev 37(4): 157-164. Doi: 10.1097/JES.0b013e3181b7b57b
5. Prieto-Hinojosa, A., Knight, A., Compton, C., et al (2014, July). Reduced thymic output in elite athletes. Brain Behav Immun 39: 75-79. Doi: 10.1016/j.bbi.2014.01.004
6. Daniels, C.J., Rajpal, S., Greenshields, J.T., et al (2021, May). Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: Results from the big ten COVID-19 cardiac registry. JAMA Cardiol. Doi: 10.1001/jamacardio.2021.2065.