Is the probability of heart involvement high in young people infected with new coronavirus?

Heart involvement in newscovid-19 inpatients is common and associated with poor prognosis

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At present, there are limited data on the prevalence and clinical relevance of cardiac involvement in non hospitalized healthy people, including young athletes

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Post viral myocarditis is a well-known cause of sudden death after exercise

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At present, experts unanimously call for the evaluation of the heart condition of athletes infected with sars-cov-2

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Therefore, using data from 42 universities, the Massachusetts General Institute as the data collection center evaluated the prevalence, clinical characteristics and prognosis of heart involvement after covid-19 infection among American college athletes

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This prospective multicenter observational cohort study was conducted from September 1, 2020 to December 31, 2020

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The primary endpoint was the prevalence of confirmed, suspected or suspected covid-19 heart involvement defined by the latest lakelouise imaging criteria

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Secondary endpoints included diagnostic rate of cardiac examination, predictors of cardiac involvement, and cardiovascular adverse events or hospitalization

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The latest lakelouise imaging diagnostic criteria should be combined with myocardial and pericardial involvement to evaluate the heart condition

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The definition of myocardial involvement was: 1) abnormal cmrt1 or late gadolinium enhanced (LGE) + abnormal T2; 2) abnormal cmrt2 + one or more supporting results (such as LVEF < 45%, pericardial effusion, pericardial enhancement, or troponin > 99% of normal upper limit)

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  Probable myocardial involvement was defined as abnormal cmrt1 or the presence of LGE + one or more supportive findings

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Suspected myocardial involvement was defined as a single abnormality of cmrt1 or the presence of LGE

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Sars-cov-2 pericardial involvement was defined as less or more pericardial effusion, or CMR showed pericardial enhancement

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If athletes have both myocardial and pericardial involvement, they will be diagnosed, suspected or suspected according to the corresponding diagnostic criteria

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  Figure a: direct CMR assessment of cardiac involvement      Figure B: according to the clinical indications, CMR was used to evaluate the cardiac involvement

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A total of 19378 athletes were included in this study, 3018 of whom (average age 20 years old; average age 20 years old) were included in the study; 32% of women) tested positive for the virus and received a cardiac assessment

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Among them, 2820 athletes received at least one cardiac “three piece” test [12 lead electrocardiogram (ECG), troponin, transthoracic echocardiography (TTE)], and then underwent cardiac magnetic resonance (CMR) examination according to clinical indications (as shown in Figure b)

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Another 198 athletes were directly screened for CMR (as shown in figure a)

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The results showed that the abnormal results of covid-19 were ECG (21 / 2999,0.7%), troponin (24 / 2719,0.9%) and TTE (24 / 2556,0.9%)

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According to the diagnostic criteria, 21 / 3018 (0.7%) athletes were diagnosed with confirmed, suspected or suspected covid-19 heart involvement

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Among them, 15 / 119 patients received CMR according to the clinical indications, and 6 / 198 patients received CMR screening directly

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Therefore, the CMR diagnosis rate of covid-19 heart involvement was 4.2 times higher than that of CMR (6 / 198,3.0%)

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After adjusting for race and gender, the predictors of covid-19 cardiac involvement included cardiopulmonary symptoms (or: 3.1,95% CI: 1.2-7.7) or at least one “three piece” test result (or: 37.4,95% CI: 13.3-105.3)

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5 (0.2%) athletes were hospitalized due to non cardiac complications of covid-19

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During the clinical monitoring period (mean follow-up 113 days [IQR: 90-146]), there was 1 case (0.03%) of adverse cardiac events that might not be related to covid-19 infection

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In conclusion, the incidence of heart involvement and adverse cardiac events of college athletes infected with covid-19 is relatively low

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Source: sars-cov-2cardiac involvement in young competitive atherlets.circulation.2021apr17.onlineaheadofprint

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