Resuming Training in High-Level Athletes After Mild COVID-19 Infection: A Multicenter Prospective Study (ASCCOVID-19)
Laurent Chevalier, Hubert Cochet, Saagar Mahida, Sylvain Blanchard S, Antoine Bénard, Tanguy Cariou, Soumaya Sridi‐Cheniti, Samy Benhenda, Stéphane Doutreleau, Stéphane Cade, Sylvain Guérard, Jean-Michel Guy, Pascale Trimoulet, Stéphane Picard, Bernard Dusfour, Aurelie Pouzet, Stéphanie Roseng, Marco Franchi, P. Jaïs, Isabelle Pellegrin, ASCCOVID Investigators, Laurent Chevalier, Isabelle Pellegrin, Michel Babeau, Akram Bensaïd, Jérémy Bernard, Sylvain Blanchard, Cédric Chadourne, Patrick Claisse, Victor Cubillé, Jean-Michel Dindart, Marco Franchi, Sophie Goguillot, Ludovic Humetz, Philippe Izard, Benjamin Laffourcade, Bernard Lemahieu, Damien Monnot, Cédric Poirier, Philippe Pouget, Jean-Louis Rebeyrol, Elliot Rubio, Carlos Vela, Quentin Vincent
Abstract
BACKGROUND: There is a paucity of data on cardiovascular sequelae of asymptomatic/mildly symptomatic SARS-Cov-2 infections (COVID). OBJECTIVES: The aim of this prospective study was to characterize the cardiovascular sequelae of asymptomatic/mildly symptomatic COVID-19 among high/elite-level athletes. METHODS: 950 athletes (779 professional French National Rugby League (F-NRL) players; 171 student athletes) were included. SARS-Cov-2 testing was performed at inclusion, and F-NRL athletes were intensely followed-up for incident COVID-19. Athletes underwent ECG and biomarker profiling (D-Dimer, troponin, C-reactive protein). COVID(+) athletes underwent additional exercise testing, echocardiography and cardiac magnetic resonance imaging (CMR). RESULTS: )]. 2.6% COVID(+) athletes had abnormal ECGs, while 0.4% had an abnormal echocardiogram. During stress testing (following 7-day rest), COVID(+) athletes had a functional capacity of 12.8 ± 2.7 METS with only stress-induced premature ventricular ectopy in 10 (4.3%). Prevalence of CMR scar was comparable between COVID(+) athletes and controls [COVID(+) vs. COVID(-); 1/102 (1.0%) vs 1/28 (3.6%)]. During 289 ± 56 days follow-up, one athlete had ventricular tachycardia, with no obvious link with a SARS-CoV-2 infection. The proportion with troponin I and CRP values above the upper-limit threshold was comparable between pre- and post-infection (5.9% vs 5.9%, and 5.6% vs 8.7%, respectively). The proportion with D-Dimer values above the upper-limit threshold increased when comparing pre- and post-infection (7.9% vs 17.3%, P = 0.01). CONCLUSION: The absence of cardiac sequelae in pauci/asymptomatic COVID(+) athletes is reassuring and argues against the need for systematic cardiac assessment prior to resumption of training (clinicaltrials.gov; NCT04936503).