Cardiac MRI has little value as a screening tool for myocarditis in competitive student athletes returning to play after recovering from COVID-19, new research indicates. "Healthcare teams should expect a low prevalence of MRI findings of myocarditis in screening programs for athletes recovering from COVID-19," Dr. Scott Reeder of the University of Wisconsin-Madison told Reuters Health by email. As he and his colleagues write in JAMA Cardiology, "the utility of cardiac MRI as a screening tool for myocarditis in this patient population is questionable." In a review of electronic health records, Dr. Reeder and colleagues identified 145 competitive athletes (mean age, 20 years; 37 women) competing in 12 sports in their Division I athletics program who were recovering from COVID-19. All of them underwent gadolinium-enhanced cardiac MRI. Most of the athletes had mild (49%) or moderate (28%) symptoms during the acute COVID infection or were asymptomatic (17%). Symptoms were not documented in the health record in 7% of athletes. None had severe symptoms or required chest radiography or hospital admission. Cardiac MRI performed at a median of 15 days after a positive COVID test was consistent with myocarditis in only two athletes (1.4%) based on updated Lake Louise criteria. One of these athletes had marked nonischemic late gadolinium enhancement and T2-weighted signal abnormalities over multiple segments, along with an abnormal serum troponin-I level. The other had 1-cm nonischemic mild late gadolinium enhancement and mild T2-weighted signal abnormalities, with normal laboratory values. Dr. Reeder noted that current guidelines, based on knowledge to date, recommend the use of cardiac MRI to evaluate for cardiac injury if there is ongoing clinical concern after evaluation with electrocardiogram, echocardiography and serum lab tests for cardiac injury. "More data, ideally prospective studies that include control subjects, are needed to improve our understanding of cardiac injury in student athletes recovering from COVID-19 infection," Dr. Reeder told Reuters Health. In a linked commentary, Dr. Jonathan Kim with Emory University in Atlanta, writes, "Based on these results and because of the poor diagnostic yield of acute myocardial inflammation, coupled with the consideration of costs, level of expertise required for interpretation of advanced CMR imaging parametric mapping techniques, and stresses placed on healthcare resources, the utility of universal CMR screening prior to return to play after COVID-19 infection appears low." Dr. Matthew W. Martinez, director of Sports Medicine for Atlantic Health System at Morristown Medical Center and consulting cardiologist for the New York Jets and PAC-12 college football conference, agrees. Dr. Martinez, who was not involved in the Wisconsin study, told Reuters Health this is a "necessary and important study, as there has been a lot of discussion about the role of MRI." "MRI is a very powerful tool and helpful tool. In the right clinical scenario, it can provide added value on top of what you might get from other imaging techniques. But as a stand-alone, first-shot sort of test, it can lead to findings that may or may not be important," said Dr. Martinez, who also works with the National Basketball Players Association and Major League Soccer. "When you search using MRI, you may end up finding minor changes inside the muscle that may or may not have clinical importance, or may or may not be related to COVID. And also, since we haven't really studied MRI routinely after common colds and viruses, these may be transient findings that have no clinical impact," he noted. "This study helps us to be able to move collegiate sports forward, because it really does help us better understand that the asymptomatic and mild groups are generally going to do well and don't require an extensive workup to allow them to return to play. The vast majority do not need MRI," Dr. Martinez told Reuters Health. —Megan Brooks Source
