Diagnosing COVID-19 myocarditis in athletes using cMRI

An early report during the SARS-CoV-2 (COVID-19) outbreak noted myocardial involvement with cardiac troponin I (cTnI) levels >99(th) percentile in approximately 20% of hospitalized patients. Patients with cTnI elevations had higher in-hospital mortality. Additionally, myocarditis is associated with exercise-related sudden cardiac death in athletes. Therefore, reports of COVID-19 myocarditis concerned the sports cardiology community, which issued two guidelines on managing athletes with COVID-19 infection. We reviewed reports of myocardial involvement in athletes after COVID-19 infection published before June 2021. The incidence of the diagnosis of myocarditis in athletes post-COVID-19 ranged from 0 to 15.4% based on cardiac magnetic resonance imaging (cMRI) performed 10 to 194 days after initial diagnosis of COVID-19. Only a few studies adhered to accepted myocarditis diagnostic guidelines and only two studies included a control group of uninfected athletes. There was significant heterogeneity in the method and protocols used in evaluating athletes post-COVID-19. The incidence of COVID-19 myocarditis in athletes appears to be over-diagnosed. The evaluation of myocarditis post-COVID-19 should be individually performed and managed according to the current guidelines. This can potentially prevent needless training restrictions and the inability to participate in competitive sports.