MRI could better detect heart inflammation detection in college athletes

Myocarditis is a rare disease of the heart and the leading cause of sudden death in competitive athletes. It affects one in 50,000 college athletes each year. Myocarditis is usually caused by a viral infection and is more common in males than females.

Recent studies have shown the presence of heart inflammation in patients who have recovered from COVID-19. Because of this, at the start of the fall 2020 season, the Big Ten Conference mandated advanced testing for all COVID-19 positive student-athletes before they could return to play.

In a study led by researchers at The Ohio State University Wexner Medical Center and College of Medicine with the 12 other Big Ten programs, results showed that a cardiac MRI of student-athletes who had COVID-19 was seven times more effective in detecting heart inflammation than symptom-based testing. This could be a game changer, especially for student-athletes who report no symptoms of the disease.

“We were surprised to find the majority of cases were asymptomatic,” said Curt Daniels, MD a cardiologist and professor at the Ohio State Wexner Medical Center who led the team of 30 researchers on the study. “We found myocardial changes among those who didn’t describe cardiac symptoms. What we don’t know is if this is clinically significant for the athlete. Is this a minor change in the heart that resolves or persists and has the potential to cause issues?”

The study looked at 1,597 COVID-19 positive Big Ten athletes who had cardiac magnetic resonance (CMR) screening. Results found 2.3% were diagnosed with myocarditis, but almost all of those student-athletes didn’t show any symptoms of the disease. Of the 37 athletes diagnosed with myocarditis, 28 didn’t exhibit symptoms.

“The challenge is that competitive athletes are used to aches and pains and working through them, and they may not report cardiac symptoms,” Daniels said. “This research helps raise awareness about asymptomatic myocarditis. Those who are diagnosed with it may need to rest and slowly ramp up exercise even though they’re not describing any cardiac symptoms.”

The conference formed the Big Ten COVID-19 Cardiac Registry to gather scientific data to help establish guidelines on when players could safely resume playing sports. The Ohio State University Institutional Review Board oversees the registry.

“The recommendation is that those diagnosed with myocarditis should rest for three months, but there’s no data to support that,” said the study’s co-author Saurabh Rajpal, MBBS, a cardiologist and assistant professor in cardiovascular medicine. “This study was the first ever to have follow-up cardiac MRIs for those diagnosed with myocarditis following COVID-19, and some showed heart inflammation resolved in as few as four weeks. But some still had scar tissue, and the question is how that will affect their health in the future.”

The next step in the research is a review of the data by experts from the Big Ten institutions who specialize in interpreting CMRs, echocardiograms and electrocardiograms. Researchers will look at which athletes would benefit from CMR testing following COVID-19 infection.

Other Ohio State Wexner Medical Center researchers involved the study were James Borchers, MD and Matthew Tong, DO.