Prevalence and diagnostic significance of de-novo 12-lead ECG changes after COVID-19 infection in elite soccer players.

BACKGROUND AND AIM: The efficacy of pre-COVID-19 and post-COVID-19 infection 12-lead ECGs for identifying athletes with myopericarditis has never been reported. We aimed to assess the prevalence and significance of de-novo ECG changes following COVID-19 infection. METHODS: In this multicentre observational study, between March 2020 and May 2022, we evaluated consecutive athletes with COVID-19 infection. Athletes exhibiting de-novo ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all players (n=30) following COVID-19 infection, despite the absence of cardiac symptoms or de-novo ECG changes. RESULTS: 511 soccer players (median age 21 years, IQR 18-26 years) were included. 17 (3%) athletes demonstrated de-novo ECG changes, which included reduction in T-wave amplitude in the inferior and lateral leads (n=5), inferior leads (n=4) and lateral leads (n=4); inferior T-wave inversion (n=7); and ST-segment depression (n=2). 15 (88%) athletes with de-novo ECG changes revealed evidence of inflammatory cardiac sequelae. All 30 athletes who underwent a mandatory CMR scan had normal findings. Athletes revealing de-novo ECG changes had a higher prevalence of cardiac symptoms (71% vs 12%, p<0.0001) and longer median symptom duration (5 days, IQR 3-10) compared with athletes without de-novo ECG changes (2 days, IQR 1-3, p<0.001). Among athletes without cardiac symptoms, the additional yield of de-novo ECG changes to detect cardiac inflammation was 20%. CONCLUSIONS: 3% of athletes demonstrated de-novo ECG changes post COVID-19 infection, of which 88% were diagnosed with cardiac inflammation. Most affected athletes exhibited cardiac symptoms; however, de-novo ECG changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.

Prevalence and diagnostic significance of novel 12-lead ecg patterns following COVID-19 infection in elite soccer players

2 Table 1Clinical Characteristics and CMR and 31P-MRS findings HV n=15 Isolated AS n=63 Diabetes and AS n=25 P value Age, y 71±4 71±12 72±7 0.73 Female, n (%) 6(40) 7(28) 25(40) 0.3 BMI, kg/m2 26±2* 27±4€ 31±4 <0.0001 Systolic BP, mmHg 136±9 132±17 131±20 0.44 HbA1c, mmol/mol 37±3* 37±4€ 56±14 <0.0001 NT- proBNP, ng/L 67[21-112] * 1411[629-2194]† 1376[390-2362] <0.0001 Euro Score II - 1.13 1.14 0.27 Rockwood Score - 2.15 2.22 0.23 CARDIAC STRUCTURAL AND FUNCTIONAL CHANGES LV end-diastolic volume indexed to BSA, mL/m2 78±15 80±22 84±21 0.53 LV end-systolic volume indexed to BSA, ml/m2 28±6 32±22 35±19 0.24 LV mass, g 102±25* 147±41† 164±59 0.0003 LV mass to LV end-diastolic volume, g/mL 0.66±0.11* 0.99±0.26† 0.96±0.25 <0.0001 LV stroke volume, ml 95±22 94±22 100±20 0.42 LV ejection fraction,% 64±3 64±12 60±12 0.25 LV maximal wall thickness, mm 10±1* 14±3† 14±3 <0.0001 RV end-diastolic volume indexed to BSA, mL/m2 83±12 79±18 78±20 0.36 RV end-systolic volume indexed to BSA, ml/m2 32±7 37±14 37±16 0.6 RV stroke volume, ml 97±17† 82±20 84±22 0.03 RV ejection fraction,% 62±5* 55±9† 54±10 0.01 LA biplane end-systolic volumes, mL 72±20 95±50 100±44 0.16 Biplane LA EF,% 59±11* 45±17 39±19 0.008 Global longitudinal strain, (-),% 16±4* 13±4† 11±4 0.001 Peak systolic circumferential strain, (-),% 21±2 1 ±5 18±5 0.11 Peak longitudinal diastolic strain rate, s-1 0.79±0.2 0.83±0.3 0.65±0.2€ 0.04 Mean native T1, (ms) 1209±79 1232±88 1262±84 0.16 Extra cellular volume, (%) 24±3 24±2 25±4 0.54 LGE, (%) - 3.1±2 3.4±4 0.85 MYOCARDIAL ENERGETICS AND PERFUSION PCr/ATP ratio 2.17±0.5* 1.74±0.4† 1.39±0.25€ <0.0001 Increase in RPP,% 25 23 25 0.5 Stress MBF, ml/min/g 2.14±0.66* 1.68±0.6† 1.24±0.3€ <0.0001 Rest MBF, ml/min/g 0.66±0.11 0.73±0.2 0.68±0.22 0.4 MPR 3.83±1.8* 2.4±0.78† 1.78±0.47€ <0.0001 € signifies p<0.05 between AS DM and AS Control, * signifies p<0.05 between AS DM and HV, † signifies p≤0.05 between AS Control and HV.Values are mean ±standard deviations or percentages. BSA indicates body surface area;LV, Left ventricle;RV, right ventricle;DM, type 2 diabetes mellitus;HCM, hypertrophic cardiomyopathy;LV, left ventricular;LA, left atrial;LA EF, left atrial ejection fraction;PCr, phosphocreatine;ATP, adenosine tri-phosphate;RPP, rate pressure product;MBF, myocardial blood flow;MPR, myocardial perfusion reserve. 2 Figure 1Cumulative incidence of the clinical events after valve replacement (AVR) is shown in the top row. Differences in myocardial PCr/ATP ratio, global stress myocardial blood flow and global longitudinal strain between healthy volunteers, patients with isolated severe AS and patients with severe AS and DM before the AVR in PCr/ATP ratio;global stress myocardial blood flow (ml/min/g) and global longitudinal strain are shown in the middle row. Changes in energetics, stress MBF and GLS after AVR are shown in the bottom row.[Figure omitted. See PDF]Conclusion3% of elite soccer players demonstrated novel ECG changes post COVID-19 infection, of which almost 90% were diagnosed with cardiac inflammation during subsequent investigation. Most athletes with novel ECG changes exhibited cardiac symptoms. Novel ECGs changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.Conflict of InterestNone

COVID-19 and its impact on the cardiovascular system.

OBJECTIVES: The clinical impact of SARS-CoV-2 has varied across countries with varying cardiovascular manifestations. We review the cardiac presentations, in-hospital outcomes and development of cardiovascular complications in the initial cohort of SARS-CoV-2 positive patients at Imperial College Healthcare National Health Service Trust, UK. METHODS: We retrospectively analysed 498 COVID-19 positive adult admissions to our institute from 7 March to 7 April 2020. Patient data were collected for baseline demographics, comorbidities and in-hospital outcomes, especially relating to cardiovascular intervention. RESULTS: Mean age was 67.4±16.1 years and 62.2% (n=310) were male. 64.1% (n=319) of our cohort had underlying cardiovascular disease (CVD) with 53.4% (n=266) having hypertension. 43.2%(n=215) developed acute myocardial injury. Mortality was significantly increased in those patients with myocardial injury (47.4% vs 18.4%, p<0.001). Only four COVID-19 patients had invasive coronary angiography, two underwent percutaneous coronary intervention and one required a permanent pacemaker implantation. 7.0% (n=35) of patients had an inpatient echocardiogram. Acute myocardial injury (OR 2.39, 95% CI 1.31 to 4.40, p=0.005) and history of hypertension (OR 1.88, 95% CI 1.01 to 3.55, p=0.049) approximately doubled the odds of in-hospital mortality in patients admitted with COVID-19 after other variables had been controlled for. CONCLUSION: Hypertension, pre-existing CVD and acute myocardial injury were associated with increased in-hospital mortality in our cohort of COVID-19 patients. However, only a low number of patients required invasive cardiac intervention.

Adapting the role of handheld echocardiography during the COVID-19 pandemic: A practical guide.

The COVID-19 pandemic has altered our approach to inpatient echocardiography delivery. There is now a greater focus to address key clinical questions likely to make an immediate impact in management, particularly during the period of widespread infection. Handheld echocardiography (HHE) can be used as a first-line assessment tool, limiting scanning time and exposure to high viral load. This article describes a potential role for HHE during a pandemic. We propose a protocol with a reporting template for a focused core dataset necessary in delivering an acute echocardiography service in the setting of a highly contagious disease, minimising risk to the operator. We cover the scenarios typically encountered in the acute cardiology setting and how an expert trained echocardiography team can identify such pathologies using a limited imaging format and include cardiac presentations encountered in those patients acutely unwell with COVID-19.