Ohio State Cardiologist Says Cardiac MRI's Can Help Give Doctors Confidence in Allowing Athletes to Return Post-CoVID

Myocarditis.

It's a word (more specifically, a medical condition) that's become a major point of contention in recent weeks, especially in the college athletics community. The heart condition was undoubtedly one of the reasons the Big Ten chose to postpone the fall sports season and it will absolutely be a major talking point on Sunday's agenda as the Big Ten discusses a return to competition. No doctor wants to put an athlete in harm's way after they've recovered from the coronavirus.

There seems to be good news emerging on that front.

According to a study published on Friday by JAMA Cardiology, “While long-term follow-up and large studies including control populations are required to understand Cardiovascular Magnetic Resonance (CMR, or MRI's of the heart) changes in competitive athletes, CMR may provide an excellent risk-stratification assessment for myocarditis in athletes who have recovered from COVID-19 to guide safe competitive sports participation.”

In other words, a team of Ohio State doctors and researchers think conducting cardiac MRI's to detect heart inflammation can severely mitigate the potential of an athlete having a heart attack on the field after they return to competition from a CoVID-19 diagnosis.

"Myocarditis is a significant cause of sudden cardiac death in competitive athletes and can occur with normal ventricular function," the study began. "Recent studies have raised concerns of myocardial inflammation after recovery from coronavirus disease 2019 (COVID-19), even in asymptomatic or mildly symptomatic patients. Our objective was to investigate the use of cardiac magnetic resonance (CMR) imaging in competitive athletes recovered from COVID-19 to detect myocardial inflammation that would identify high-risk athletes for return to competitive play."

“The focus of our study was to see if we could do a test that could allow safe resumption of sports for those athletes, so that the doctors who are seeing these athletes feel safe about sending them back to competitive play. And if you rule out myocarditis by MRI, then sports cardiologists will feel safe about sending these athletes back into action,” said Ohio State cardiologist Saurabh Rajpal, the lead author of the study.

The study consisted of 26 college athletes that had recovered from CoVID-19. Using the CMR testing, four of the 26 had inflammation of the heart muscle (a significant indication of myocarditis). Eight of the other athletes were found to have late gadolinium enhancement. According to the National Institute of Health, late gadolinium enhancement is a useful tool for scar detection, based on differences in the volume of distribution of gadolinium, an extracellular agent.

Rajpal said this could be indicative of a prior heart injury like a virus, but could also simply indicate athlete heart adaptation due to how strenuously they exercise.

Myocarditis is not a new phenomenon, but it's getting an awful lot of attention because of the pandemic.

“If somebody has swelling in their heart, and they keep on doing that high intense level of exercise, they are at risk of abnormal heart rhythms, and this could sometimes lead to death,” Rajpal told Eleven Warriors. “These are rare instances, I would point out, and myocarditis by itself is very uncommon. It’s not a common disease. But because the viral infection has affected so many people, we are talking about it more.”

“When we started doing the study, our goal was to find something that we can feel safe about sending these athletes back,” Rajpal continued. “In addition to doing the usual testing, in our opinion that was to do an MRI. So if you do an MRI, and the heart does not show myocarditis, at OSU we are letting the athletes go back to practice. We are letting them go back to usual intensity of exercise if their MRI was negative.”

The next step for the study would be to conduct CMR's on athletes that have not tested positive for CoVID-19 and compare their results to athletes that have had the virus. In addition, the data from this study is hardly statistically conclusive considering it only tested 26 patients. But it's certainly a good start and the positive results could be enough to sway Big Ten presidents and chancellors that this condition shouldn't be a sole reason to keep football players off the field.

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