Introduction:

During the ongoing Coronavirus disease 2019 (Covid-19)-pandemic many elite athletes suffered an infection with the novel Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Initial data demonstrated often severe systemic disease including myocardial injury in Covid-19-patients from the general population. First studies focusing on the athletic population also suggested high rates of myocardial inflammation (up to 1/3^rd of cases). Further, larger investigations alleviated initial concerns by demonstrating mostly mild or asymptomatic Covid-19-cases in athletes with very low rates of myocardial complications. These studies focused mainly on MRI-derived images regarding potential myocardial inflammation. Data regarding myocardial function in athletes (i. e. strain analysis) is based on cross-sectional or retrospective analyses and remains limited and heterogeneous: While some trials demonstrate reductions in right ventricular or left ventricular global longitudinal strain in comparison to control groups, others do not detect these differences. Thus, to further the understanding of potential effects of a Covid-19-infection on myocardial function in elite athletes, the present study is the first longitudinal pre-post-comparison of speckle-tracking derived strain analyses.

Methods:

27 elite athletes from the German National Olympic Team who presented for a sports-cardiological assessment as part of our return-to-play-strategy after a Covid-19-infection were included. All of these athletes had presented to our institution in the 18 months prior to their infection for a routine sports medical screening, including a state-of-the-art echocardiography. Thus, high quality echocardiography images were available before and shortly after the Covid-19-infection, allowing for a longitudinal pre-post-comparison. Routine echocardiographic parameters were documented as well as radial, circumferential and longitudinal strain values via speckle tracking analysis. Normal distribution was assessed via Shapiro Wilk test. The pre-post-comparison was conducted using the paired T-Test.  

Results:

The study cohort was composed of 12 female and 15 male elite athletes: Age 24±4 years, height 179±11 cm, weight 73±14 kg. Sporting disciplines included Athletics, Fencing, Judo, Taekwondo, Swimming, Basketball, Gymnastics, Boxing, Rowing and Cycling. No relevant differences were documented between routine echocardiography parameters. The ejection fraction (EF) was 56.60±4,04 % before and 57.33±5,50 % after the infection (p=0,37). Global longitudinal strain was -20.25±2,07 % before and -20.19±2,16 % after the infection (p=0.92). The global values for circumferential and radial strain were also without significant differences (-17.48±5,04 % vs. -18.49±3,48 %, p=0,31 and 36.39±17,57 % vs 41.87±18,57 %, p=0,41, respectively).

Conclusion:

To the authors knowledge this is the first longitudinal pre-post-comparison of myocardial function in a cohort of elite athletes after a Covid-19-infection. Myocardial function assessed by strain analysis did not differ before and after the infection and average-values were well within the reference ranges for healthy athletes. Our data further the understanding of the effects of the infection on the cardiovascular health in athletes, underscoring the growing consensus that the vast majority of athletes recovers fully with no measurable myocardial damage.