Is cardiac involvement prevalent in highly trained athletes after SARS-CoV-2 infection? A cardiac magnetic resonance study using sex-matched and age-matched controls

ObjectivesTo investigate the cardiovascular consequences of SARS-CoV-2 infection in highly trained, otherwise healthy athletes using cardiac magnetic resonance (CMR) imaging and to compare our results with sex-matched and age-matched athletes and less active controls.MethodsSARS-CoV-2 infection was diagnosed by PCR on swab tests or serum immunoglobulin G antibody tests prior to a comprehensive CMR examination. The CMR protocol contained sequences to assess structural, functional and tissue-specific data.ResultsOne hundred forty-seven athletes (94 male, median 23, IQR 20–28 years) after SARS-CoV-2 infection were included. Overall, 4.7% (n=7) of the athletes had alterations in their CMR as follows: late gadolinium enhancement (LGE) showing a non-ischaemic pattern with or without T2 elevation (n=3), slightly elevated native T1 values with or without elevated T2 values without pathological LGE (n=3) and pericardial involvement (n=1). Only two (1.4%) athletes presented with definite signs of myocarditis. We found pronounced sport adaptation in both athletes after SARS-CoV-2 infection and athlete controls. There was no difference between CMR parameters, including native T1 and T2 mapping, between athletes after SARS-CoV-2 infection and the matched athletic groups. Comparing athletes with different symptom severities showed that athletes with moderate symptoms had slightly greater T1 values than athletes with asymptomatic and mildly symptomatic infections (p<0.05). However, T1 mapping values remained below the cut-off point for most patients.ConclusionAmong 147 highly trained athletes after SARS-CoV-2 infection, cardiac involvement on CMR showed a modest frequency (4.7%), with definite signs of myocarditis present in only 1.4%. Comparing athletes after SARS-CoV-2 infection and healthy sex-matched and age-matched athletes showed no difference between CMR parameters, including native T1 and T2 values

Frequent Constriction-Like Echocardiographic Findings in Elite Athletes Following Mild COVID-19: A Propensity Score-Matched Analysis

Background: The cardiovascular effects of SARS-CoV-2 in elite athletes are still a matter of debate. Accordingly, we sought to perform a comprehensive echocardiographic characterization of post-COVID athletes by comparing them to a non-COVID athlete cohort. Methods: 107 elite athletes with COVID-19 were prospectively enrolled (P-CA; 23 ± 6 years, 23% female) 107 healthy athletes were selected as a control group using propensity score matching (N-CA). All athletes underwent 2D and 3D echocardiography. Left (LV) and right ventricular (RV) end-diastolic volumes (EDVi) and ejection fractions (EF) were quantified. To characterize LV longitudinal deformation, 2D global longitudinal strain (GLS) and the ratio of free wall vs. septal longitudinal strain (FWLS/SLS) were also measured. To describe septal flattening (SF—frequently seen in P-CA), LV eccentricity index (EI) was calculated. Results: P-CA and N-CA athletes had comparable LV and RVEDVi (P-CA vs. N-CA; 77 ± 12 vs. 78 ± 13mL/m2; 79 ± 16 vs. 80 ± 14mL/m2). P-CA had significantly higher LVEF (58 ± 4 vs. 56 ± 4%, p < 0.001), while LVGLS values did not differ between P-CA and N-CA (−19.0 ± 1.9 vs. −18.8 ± 2.2%). EI was significantly higher in P-CA (1.13 ± 0.16 vs. 1.01 ± 0.05, p < 0.001), which was attributable to a distinct subgroup of P-CA with a prominent SF (n = 35, 33%), further provoked by inspiration. In this subgroup, the EI was markedly higher compared to the rest of the P-CA (1.29 ± 0.15 vs. 1.04 ± 0.08, p < 0.001), LVEDVi was also significantly higher (80 ± 14 vs. 75 ± 11 mL/m2, p < 0.001), while RVEDVi did not differ (82 ± 16 vs. 78 ± 15mL/m2). Moreover, the FWLS/SLS ratio was significantly lower in the SF subgroup (91.7 ± 8.6 vs. 97.3 ± 8.2, p < 0.01). P-CA with SF experienced symptoms less frequently (1.4 ± 1.3 vs. 2.1 ± 1.5 symptom during the infection, p = 0.01). Conclusions: Elite athletes following COVID-19 showed distinct morphological and functional cardiac changes compared to a propensity score-matched control athlete group. These results are mainly driven by a subgroup, which presented with some echocardiographic features characteristic of constrictive pericarditis

Abortált hirtelen szívhalál egy 39 éves biztonsági őrnél = Aborted sudden cardiac death in a 39-year-old security guard

A nonobstruktív koronáriákkal járó szívinfarktus, azaz MINOCA, az infarktusok megközelítőleg 6-8%-át teszi ki. Esetismertetésünkben egy 39 éves biztonsági őr történetét mutatjuk be, aki éjszakai szórakozást követően érkezett a háziorvosi ügyeletre epigasztriális fájdalom, verejtékezés, fáradtság- és gyengeségérzés miatt. A megkezdett vizsgálat közben keringésmegállás jelentkezett, azonnali reanimaciót kezdtek automata külső defibrillátor segítségével, amely sokkolandó ritmust detektált. Öt DC-sokk után a spontán keringés visszatért. Heteroanamnézis alapján néhány órával korábban a beteg designer drogot fogyasztott. Az ügyeletes PCI-centrumban elvégzett akut koronarográfia során ép epikardiális koszorúereket találtak. A szívultrahang-vizsgálat megtartott szisztolés balkamra-funkciót igazolt. A keringésleállás hátterében több etiológiai tényező is felmerült, azonban a valódi ok tisztázatlan maradt. Betegünk posztreszuszcitációs ellátást követően érkezett a Városmajori Szív- és Érgyógyászati Klinikára további kardiológiai kivizsgálás, esetleges ICD-implantáció elbírálása céljából. Érkezésekor készített 12-elvezetéses EKG-felvételen jobb Tawara-szár-blokk, és a mellkasi V1- és V2-elvezetésben ST-szakasz-eleváció, valamint Q-hullám volt látható. Az etiológia tisztázása céljából szív mágneses rezonanciás (CMR) vizsgálatot végeztünk, amely a típusos eltérések alapján akut szeptális szívinfarktust igazolt. Esetünk hangsúlyozza, hogy a negatív koronarográfiás vizsgálat nem zárja ki az akut szívinfarktus lehetőségét, és a rutinszerűen elvégzett diagnosztikus vizsgálatok ellenére is fennálló differenciáldiagnosztikai nehézség esetén a CMR-vizsgálat segíthet a diagnózis tisztázásában. = Myocardial infarction with non-obstructive coronary arteries, the so called MINOCA is responsible for up to 6-8% of the infarctions. In our case presentation we aim to describe the story of a 39-year-old security guard who after a night of going out visited his GP doctor with the symptoms of acute epigastric pain, sweating, fatigue and general weakness. During physical examination, the patient had a cardiac arrest and resuscitation was performed immediately with an automatic external defibrillator. After five DC shocks the patient was successfully resuscitated. According to heteroanamnestic information he has taken designer drugs a few hours prior to the incident. The patient was taken to the PCI centre on duty and during the acute coronary angiography normal coronary arteries were observed. Transthoracic echocardiography showed preserved left ventricular systolic function. Several etiologic factors have arisen in the background of circulatory arrest, but the real cause remained unclear. Our patient arrived at the Heart and Vascular Centre after post-resuscitation therapy for further cardiac evaluation and consideration of an ICD device implantation. Upon his admission his resting 12-lead ECG showed that there was a right bundle branch block, ST-segment elevation and Q-wave in precordial V1 and V2 leads. For the etiological clarification we performed a cardiac magnetic resonance (CMR) examination, which showed typical signs of acute septal myocardial infarction. Our case highlights that normal coronary angiography does not exclude acute myocardial infarction. In case of differential diagnostic difficulties despite of the routinely preformed diagnostic tests, CMR can help to clarify the diagnosis

Prognosis of the non-ST elevation myocardial infarction complicated with early ventricular fibrillation at higher age

Early ventricular fibrillation (EVF) predicts mortality in ST-segment elevation myocardial infarction (STEMI) patients. Data are lacking about prognosis and management of non-ST-segment elevation myocardial infarction (NSTEMI) EMI with EVF, especially at higher age. In the daily clinical practice, there is no clear prognosis of patients surviving EVF. The present study aimed to investigate the risk factors and factors influencing the prognosis of NSTEMI patients surviving EVF, especially at higher age. Clinical data, including 30-day and 1-year mortality of 6179 NSTEMI patients, were examined; 2.44% (n=151) survived EVF and were further analyzed using chi-square test and uni- and multivariate analyses. Patients were divided into two age groups below and above the age of 70 years. Survival time was compared with Kaplan-Meier analysis. EVF was an independent risk factor for mortality in NSTEMI patients below (HR: 2.4) and above the age of 70 (HR: 2.1). Mortality rates between the two age groups of NSTEMI patients with EVF did not differ significantly: 30-day mortality was 24% vs 40% (p=0.2709) and 1-year mortality was 39% vs 55% (p=0.2085). Additional mortality after 30 days to 1 year was 15% vs 14.6% (p=0.9728). Clinical characteristics of patients with EVF differed significantly from those without in both age groups. EVF after revascularization-within 48 h-had 11.2 OR for 30-day mortality above the age of 70. EVF in NSTEMI was an independent risk factor for mortality in both age groups. Invasive management and revascularization of NSTEMI patients with EVF is highly recommended. Closer follow-up and selection of patients (independent of age) for ICD implantation in the critical first month is essential

Balkamra-hipertrófiával, illetve megnövekedett falvastagsággal járó cardiomyopathiák szív mágneses rezonanciás jellegzetességei = Cardiac magnetic resonance „fingerprints” of cardiomyopathies with myocardial hypertrophy or increased left vent­ricular wall thickness

A szív mágneses rezonancia (CMR) vizsgálat a bal kamrai izomtömeg meghatározásának referenciamódszere. A hipertrófiamintázat, illetve kötőszövetes elfajulás jellegzetességének azonosításával a CMR-vizsgálat jelentős segítséget nyújthat a hipertrófiával járó cardiomyopathiák (CMP) differenciáldiagnózisában. Kutatásunk célja volt a bal kamrai hipertrófiával járó CMP-k CMR jellegzetességeinek és prevalenciájának tanulmányozása. CMR-adatbázisunk alapján 2013 és 2017 között 186 esetben igazolódott kóros balkamra-hipertrófiát, illetve 12 mm-t meghaladó bal kamrai falvastagságot okozó cardiomyopathia. A vizsgálatból kizártuk azokat a betegeket, akik anamnézisében kezeletlen hipertónia, aortastenosis szerepelt, illetve azon versenysportolókat, akiknél fiziológiás hipertrófia igazolódott. Meghatároztuk a bal kamrai ejekciós frakciót, volumeneket, izomtömeg-indexet és a maximális végdiasztolés falvastagságot. Vizsgáltuk a fibrózist jelző késői típusú kontraszthalmozás mintázatát. Hipertrófiás cardiomyopathiára (HCM) jellegzetes képet láttunk 135 felnőttnél (78 férfi) és 13 gyereknél (7 fiú), közülük 25 esetben csúcsi HCM-et diagnosztizáltunk. Amyloidosist jelző koncentrikus balkamra-hipertrófiát és diffúz, körkörös subendocardialis bal kamrai halmozást találtunk 23 esetben (12 férfi). A bal kamra morfológiája és a basalis inferolateralis szegmentum kontraszthalmozása hét esetben (3 férfi) Anderson–Fabry-kórra volt jellegzetes. Nyolc esetben (1 férfi) a csúcsi/subvalvuláris endocardialis halmozás alapján endomyocardialis fibrózist (EMF) diagnosztizáltunk, öt esetben jobb kamrai érintettséggel. Az egyes CMP-k CMR „ujjlenyomatának” megismerése a továbbiakban a még pontosabb diagnosztikát segítheti. = Cardiac magnetic resonance (CMR) imaging is the gold standard method to determine left ventricular mass. Moreover it is a useful technique to differentiate various cardiomyopathies (CMP) by identifying the typical patterns of left ventricular hypertrophy and fibrosis. The aim of our study was to evaluate the characteristic features and prevalence of different cardiomyopathies with increased left ventricular wall thickness. Based on our CMR database cardiomyopathy with pathological left ventricular hypertrophy or more than 12 mm wall thickness was proved in 186 cases between 2013 and 2017. Patients with untreated hypertension, aortic stenosis and professional athletes with physiological hypertrophy were excluded from the study. We evaluated left ventricular ejection fraction, volumes, mass index and maximal end-diastolic wall thickness. The patterns of delayed contrast enhancement were investigated. CMR images were typical of hypertrophic cardiomyopathy (HCM) in 135 adult patients (78 male) and 13 children (7 male), in 25 cases apical HCM was diagnosed. In 23 patients (12 male) concentric hypertrophy and diffuse, circular subendocardial left ventricular contrast enhancement were typical for amyloidosis. Left ventricular morphology and inferolateral basal midmyocardial contrast enhancement were typical of Anderson-Fabry disease in seven cases (3 male). CMR characteristics were typical of endomyocardial fibrosis in eight patients (1 male), with typical apical/subvalvular endocardial contrast enhancement. Right ventricular involvement was found in five patients. Recognition of CMR fingerprints of cardiomyopathies can further assist us with diagnosing cardiomyopathies with increased left ventricular wall thickness

The Impact of COVID-19 on the Preparation for the Tokyo Olympics: A Comprehensive Performance Assessment of Top Swimmers

Background: The Olympic preparation of athletes has been highly influenced by COVID and post-COVID syndrome. As the complex screening of athletes is essential for safe and successful sports, we aimed to repeat the 2019-year sports cardiology screening of the Olympic Swim Team before the Olympics and to compare the results of COVID and non-COVID athletes. Methods: Patient history, electrocardiogram, laboratory tests, body composition analysis, echocardiography, cardiopulmonary exercise test (CPET) were performed. We used time-ranking points to compare swimming performance. Results: From April 2019, we examined 46 elite swimmers (24 ± 4 years). Fourteen swimmers had COVID infection; all cases were mild. During CPET there was no difference in the performance of COVID (male: VO2 max 55 ± 4 vs. 56.5 ± 5 mL/kg/min, p = 0.53; female: VO2 max 54.6 ± 4 vs. 56 ± 5.5 mL/kg/min, p = 0.86) vs. non-COVID athletes (male VO2 max 56.7 ± 5 vs. 55.5 ± 4.5 mL/kg/min, p = 0.50; female 49.6 ± 3 vs. 50.7 ± 2.6 mL/kg/min, p = 0.47) between 2019 and 2021. When comparing the time results of the National Championships, 54.8% of the athletes showed an improvement (p = 0.75). Conclusions: COVID infection with short-term detraining did not affect the performance of well-trained swimmers. According to our results, the COVID pandemic did not impair the effectiveness of the preparation for the Tokyo Olympics