Systematic cardiac screening before returning to play in athletes after SARS-CoV-2 infection

INTRODUCTION: SARS-CoV-2 infection can induce cardiac damages. Therefore, in the absence of clear data, a systematic cardiac evaluation was recommended for athletes before return-to-play after recent SARS-CoV-2 infection. OBJECTIVE: To assess the prevalence of anomalies detected by this systematic cardiac screening. METHOD: We reviewed the medical files of elite athletes referred for cardiac evaluation before return to play after a non-hospitalized SARS-CoV-2 infection (based on a positive PCR or antigen test), from March 2020 to July 2021, in 12 French centers. RESULTS: In total, 554 high level athletes were included (mean age 23 ± 6 years), mostly male (72%). An ECG, echocardiography and exercise test was performed respectively in 551 (99.5%), 497 (89.7%) and 293 (52.9%) of athletes. We found anomalies with a potential link with SARS-CoV-2 infection in 4 ECG (0.7%), 3 echocardiographies (0.6%) and 3 exercises test (1.0%). Cardiac magnetic resonance imaging was performed in 34 athletes (6.1%), mostly due to abnormal first line examinations, and was abnormal in 1 (2.9%). The rate of those abnormalities was not higher in case of cardiac symptoms or in patients with more severe forms of non-hospitalized SARS-CoV-2 infection. Only one had a possible SARS-CoV-2 myocarditis and was temporally contraindicated to return-to-play. None had a major cardiac event declared during the follow-up (Fig. 1). CONCLUSION: The prevalence of cardiac involvement after non-hospitalized forms of SARS-CoV-2 infection in athletes are very low. A systematic cardiac screening before return-to-play seems not be mandatory in the majority of athletes.