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Heart problems related to COVID-19 may be rare in pro athletes who have recovered

A baseball player wears a face mask
A baseball player wears a face mask as he walks to a drill during spring training with the San Diego Padres in Peoria, Ariz.
(Charlie Riedel / Associated Press)

Heart inflammation is uncommon in pro athletes who’ve had mostly mild cases of COVID-19, and most don’t need to be sidelined as a result of their illnesses, a study conducted by major professional sports leagues suggests.

The results are not definitive, experts from outside the leagues say, and more independent research is needed. But the study published Thursday in JAMA Cardiology is the largest to examine the scope of the problem. A coronavirus infection can cause inflammation in many organs, including the heart.

The research involved professional athletes who play football, hockey, soccer, baseball and men’s and women’s basketball. All tested positive for the coronavirus before October and were given guideline-recommended heart tests, nearly 800 total.

None of the players developed severe cases of COVID-19, and 40% had few or no symptoms — what might be expected from a group of healthy elite athletes with an average age of 25. Severe COVID-19 is more common in older people and those with chronic health conditions.

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Almost 4% of the athletes had abnormal results on heart tests that were done after they recovered, but subsequent MRI exams found heart inflammation in less than 1% of the athletes. These five athletes all had COVID-19 symptoms. Whether their heart problems were caused by the virus is unknown, although the researchers think that is likely.

They were sidelined for about three months and returned to play without any problems, said study leader Dr. Mathew Martinez, a sports cardiologist at Morristown Medical Center in New Jersey. Martinez is the team cardiologist for the New York Jets pro football team.

Two previous smaller studies in college athletes recovering from COVID-19 suggested heart inflammation might be more common. The question is of key interest to athletes, who put extra stress on their hearts during play. Undetected heart inflammation has been linked with sudden death.

The lasting effects of COVID-19 on the heart are limited to a small subset of patients, studies show.

Whether mild COVID-19 can cause heart damage “is the million-dollar question,” said Dr. Richard Kovacs, co-founder of the American College of Cardiology’s Sports & Exercise Council. And whether severe COVID-19 symptoms increase the chances of having fleeting or long-lasting heart damage ‘’is part of the puzzle,’’ he said.

Kovacs said the study has several weaknesses. Testing was done at centers affiliated with or selected by each team, and the results were interpreted by team-affiliated cardiologists, increasing the chances of bias. A more rigorous investigation would have had standardized testing done at a central location and more objective specialists interpret the results, he said.

Also, many of the athletes had no previous imaging exams to compare the results with, so there is no way to know for certain if abnormalities found during the study were related to the virus.

“There is clearly more work to do, but I think it is very helpful additional evidence,” said Dr. Donald Lloyd-Jones, president-elect of the American Heart Assn.

Positive coronavirus tests dip below the threshold to allow outdoor high school sports competition in Los Angeles and Orange counties.

Dr. Dial Hewlett, a member of a COVID-19 task force at the National Medical Assn., which represents Black physicians, said the study “is extremely timely.” Hewlett is a deputy health commissioner for New York’s Westchester County and advises high schools and colleges on when to allow young athletes to return to play after COVID-19 infections.

“I’m grateful that we are starting to get some data to help guide us in some of our decisions,” Hewlett said.


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