A study of more than 3,000 college athletes with COVID-19 released Saturday found so few cases of heart problems that future heart tests may only be used on athletes with certain symptoms.

In a study published in the Journal of the American Heart Association Circulation, researchers found evidence of possible, probable or definite myocarditis or heart inflammation in 21 of 3,018 athletes (0.7%) who tested positive for COVID-19. It was also found that athletes with heart disease were more likely to have moderate COVID-19 levels and/or cardiopulmonary symptoms.

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Dr. Jonathan Drezner, director of the Sports Cardiology Medical Center at the University of Washington and co-leader of the study, said the results will help universities and the NCAA improve cardiac screening protocols for athletes who test positive for COVID-19.

For athletes who have only mild symptoms or no symptoms at all, it’s not clear whether testing is necessary, he added. And I would feel comfortable controlling the symptoms and making sure they felt good when they went back to play.

Drezner was an NCAA advisor, and NCAA medical director Dr. Brian Heinlein was a member of the study group’s steering committee. Male and female athletes from 42 colleges and institutes in 26 sports participated in the study.

The low prevalence of post-COVID-19 myocarditis among the study’s varsity athletes, as well as its association with moderate to cardiac symptoms, is similar to the findings of a larger study of professional athletes published last month.

Dr. Aaron Baggish, director of the cardiovascular performance program at Massachusetts General Hospital in Boston, who was involved in both studies, said the peer-reviewed study included nearly four times as many athletes, a third of whom were women (compared to just 1.5 percent in the study of professional athletes), and provided more detailed information about symptoms.

Some previous smaller studies have shown significantly higher rates of myocarditis after administration of COVID-19 to athletes, including about 15% in a study with about two dozen athletes at Ohio State. This has raised concerns among medical experts and university sports administrators who make decisions about returning to the game.

Last year, it was common for schools to administer a heart test to all athletes who tested positive for COVID-19. A common triad protocol consisted of an electrocardiogram, a blood test for troponin protein and an echocardiogram – or ultrasound – of the heart. In some cases, students also underwent an MRI of the heart.

According to Mr. Drezner, an MRI of the heart should only be performed if the athlete has moderate symptoms, such as fever, body aches, bed rest, cardiopulmonary symptoms, abnormalities on any of the triad tests or cardiopulmonary problems after returning to play. In his opinion, the use of an expensive and not widely available cardiac MRI as an initial screening may lead to overdiagnosis and unnecessary limitations of the athlete’s game. He said there’s potential damage.

Of the 21 confirmed cases of possible cardiac problems, cardiac MRI showed 11 cases of definite or probable myocardial or myopericardial problems; nine of these were cases in which the athlete had moderate or cardiopulmonary symptoms or showed abnormal symptoms on any of the tests in the triad.

Baggish wrote in an email that schools can use the study’s results to waive complicated testing for student-athletes with asymptomatic or mild conditions, provided they fully recover and return to physical activity without problems, [and] limit expensive and sometimes complicated heart tests for student-athletes with moderate to more significant symptoms or signs upon return to physical activity.

The researchers also determined that COVID-19 did not cause a heart attack or similar event in the athletes who participated in the study; although one athlete suffered a cardiac arrest, it was determined that this event was probably not related to the coronavirus, Drezner said.

If you look around the country, there are 8 million high school athletes with an infection rate of about 10%. The college probably has a 20% infection rate. And we just don’t hear about these unwanted incidents, Drezner said. It’s also indirectly reassuring.

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