Ohio State Cardiologist Says Cardiac MRIs Can Help Doctors “Feel Safe” About Athletes Returning to Play After Covid

In the midst of the debates about the risks of playing sports during the covid pandemic, a group of Ohio State doctors and researchers conducted a study using cardiac MRIs (CMR) to detect symptoms associated with myocarditis in college athletes who had tested positive for the virus. Concerns surrounding the links between covid and heart issues, specifically myocarditis, was one of the reasons why the Big Ten decided to postpone fall sports on August 11th 2020. Whether the Big Ten votes in favor of playing football this fall this week could depend, in part, on whether the conference is confident it can mitigate those risks.

One way the Big Ten could make that happen is using CMR to detect possible cases of myocarditis in athletes who test positive for covid. While long-term follow-up and large studies including control populations are required to understand CMR changes in competitive athletes, CMR may provide an excellent risk-stratification assessment for myocarditis in athletes who have recovered from covid to guide safe competitive sports participation. The focus of the study was to see if researchers could do a test that could allow safe resumption of sports for those athletes, so that the doctors who are seeing these athletes feel safe about sending them back to competitive play.

And if you rule out myocarditis by CMR, then sports cardiologists will feel safe about sending these athletes back into action. Ohio State’s study tested 26 competitive college athletes, and found swelling of the heart muscle indicating probable myocarditis in four of them. Eight other athletes had late gadolinium enhancement, which could be indicative of a prior heart injury like a virus, but could also simply indicate athlete heart adaptation due to how strenuously they exercise.

Because the study only involved 26 athletes, the data was not enough to draw any statistically significant conclusions about how high the risk of myocarditis associated with covid is.

At Ohio State, though, CMRs have been used to clear athletes to return to practice, in addition to the typical tests team doctors would conduct on athletes after they have been sick. When the doctors started doing the study, their goal was to find something that they can feel safe about sending the athletes back. In addition to doing the usual testing, in the doctors’ opinion that was to do an CMR.

So if you do an CMR, and the heart does not show myocarditis, at Ohio State University (OSU) the doctors are letting the athletes go back to practice. The doctors are letting the athletes go back to usual intensity of exercise if their CMR was negative. The threat of myocarditis has to be taken seriously by team doctors because it has been identified as a cause of sudden cardiac death in athletes.

If an athlete has the condition and returns to action too soon, there could be grave consequences. Myocarditis is not a new phenomenon and it can be caused by other viruses as well. Myocarditis is simply getting more attention now because of how widespread the covid pandemic is. If a person has swelling in their heart, and he keeps on doing that high intense level of exercise, he is at risk of abnormal heart rhythms, and this could sometimes lead to death.

These are rare instances, and myocarditis by itself is very uncommon.

Myocarditis is not a common disease. But because the viral infection has affected so many people, the doctors are talking about it more. James Borchers, the head physician for the Ohio State football team, was among those who co-authored the study Borchers is now serving as the co-chair of the medical subcommittee of the Big Ten’s return to competition task force, whose plans for returning to play were received positively by a steering committee of eight Big Ten presidents and chancellors, which could lead to a vote on playing this fall.

When Borchers was asked about myocarditis by Ohio Governor Mike DeWine during DeWine’s briefing on August 18th 2020, Borchers indicated that myocarditis was something doctors need to be aware of, but also something they do not need to be overly scared of. Aaron Baggish, the director of the cardiovascular performance program at Massachusetts General Hospital, said on the National Collegiate Athletic Association (NCAA)’s official social media account that he does not believe concerns about myocarditis should be a reason not to play college sports, believing that proper protocol can identify athletes who develop cardiac symptoms and keep them out of action until they fully recover. The algorithms the researchers have put into place are going to identify the high-risk athletes that should be restricted, and that should be an individual decision among team physicians, sports cardiologists, and the athlete who is a patient.

The decision to play football or other collegiate sports right now is much more about the ability to contain transmission of covid as a public health issue rather than a cardiology issue. As for Ohio State’s research, the next step will include doing CMRs on athletes who have not tested positive for covid in order to compare their results against those who have. The researchers will also do follow-up scans on athletes who have shown symptoms of myocarditis to see how the athletes recover, while the researchers also plan to test for blood markers to see if they can identify any indicators linked to myocarditis.

Ultimately, Ohio State’s research could allow the researchers to draw more conclusions about how high the risk is of developing myocarditis as a result of a covid infection as well as whether there are other factors that make someone who contracts covid more likely to end up with heart-related issues, but the researchers are not there yet.

There have been many studies that have shown the heart can be affected as a result of covid. The researchers just have to get more data and do more research to define how to identify that population in which the heart is affected. And then move on and figure out what would be the next step to minimize danger, and move on from there.