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Ohio State Cardiologist Says Cardiac MRI Can Help Doctors “Feel Safe” About Athletes Returning to Play After COVID-19

Concerns about links between COVID-19 and heart problems, especially myocarditis, were one of the reasons the Big Ten decided to postpone fall sports on August 11.

Whether the top ten votes in favor of football this fall this week may be partly down to the conference being confident it can mitigate these risks.

One way the Big Ten could make it happen: Use cardiac MRI to detect possible cases of myocarditis in athletes who test positive for COVID-19.

In the midst of the debates that have taken place in the Big Ten and across the country about the risks of playing sports during the COVID-19 pandemic, a group of doctors and researchers from Ohio State conducted a study using cardiac magnetic resonance imaging, known also as CMR ̵

1; to detect symptoms associated with myocarditis in college athletes who tested positive for the virus.

One of the conclusions of that study, published on Friday: “Although long-term follow-up and large studies that include control populations are needed to understand changes in CMR in competitive athletes, CMR can provide an excellent assessment of risk stratification. for myocarditis in athletes who have recovered from COVID-19 to lead safe competitive sports participation. ”

“The goal of our study was to see if we could do a test that would allow safe resumption of sports for those athletes, so that the doctors who are seeing these athletes feel confident to send them back to competitive play. And if magnetic resonance myocarditis is ruled out, sports cardiologists will feel confident to send these athletes back into action, ”said Ohio State cardiologist Saurabh Rajpal, lead author of the study.

The Ohio State study tested 26 competitive college athletes and found swelling of the heart muscle indicating probable myocarditis in four of them. Eight other athletes were found to have late gadolinium enhancement, which Rajpal said could be indicative of a previous heart injury such as a virus, but could also simply indicate the athlete’s cardiac adaptation due to how intensely he exercises.

Since the study only involved 26 athletes, Rajpal said the data were not sufficient to draw statistically significant conclusions about how high the risk of myocarditis associated with COVID-19 is. Furthermore, he did not want to decide whether to play sports during the pandemic. In the state of Ohio, however, cardiac MRIs have been used to allow athletes to return to training, in addition to the typical tests that team doctors would conduct on athletes after they fell ill.

“When we started doing the study, our goal was to find something we could feel safe about sending these athletes back,” said Rajpal. Eleven warriors. “In addition to doing the usual tests, in our opinion that was doing an MRI. So, if you do an MRI and the heart doesn’t show myocarditis, at the OSU we’ll let the athletes get back to training. We are letting them return to normal exercise intensity if their MRI was negative. ”

The threat of myocarditis – inflammation of the heart muscle – must 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 gets back into action too soon, there could be serious consequences.

However, myocarditis is not a new phenomenon and can also be caused by other viruses; it is simply getting more attention now due to how widespread the COVID-19 pandemic has been.

“If someone has swelling in their heart and continues to do that intense level of exercise, they are at risk for abnormal heart rhythms and this could sometimes lead to death,” Rajpal said. “These are rare cases, I would like to point out, and myocarditis itself is very rare. It is not a common disease. But since the viral infection has affected so many people, we’re talking more about it. ”

James Borchers, the primary of the Ohio State football team, was among those who collaborated on the study with Rajpal. He is now serving as co-chair of the Big Ten return to competition task force medical subcommittee, whose plans to return to play were welcomed by a steering committee of eight Big Ten presidents and chancellors on Saturday, which could lead to a vote on reproduction this fall as soon as Sunday. When asked about myocarditis by Ohio Governor Mike DeWine during the DeWine briefing on Aug. 18, he indicated that it was something doctors “need to be aware of,” but also something they don’t “need to be overly aware of. frightened. ”

Aaron Baggish, the director of the cardiovascular performance program at Massachusetts General Hospital, said Friday during a broadcast on the Official NCAA social media account who does not believe that myocarditis concerns 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 we have put in place, I firmly believe, will identify high-risk athletes who should be limited, and this should be an individual decision between the team doctors, sports cardiologists and the athlete who is a patient,” Baggish he said. “The decision to play football or other collegiate sports right now is much more, in my opinion, about the ability to contain the transmission of this virus as a public health problem rather than a cardiology problem.”

As for the Ohio State research, Rajpal says the next step will include performing cardiac MRI scans on athletes who have not tested positive for COVID-19 in order to compare their results with those who have. They will also do follow-up scans on athletes who have shown symptoms of myocarditis to see how they recover, while they also plan to test blood markers to see if they can identify any markers related to myocarditis.

Ultimately, Ohio State research could allow them to draw further conclusions about how high the risk of developing myocarditis is as a result of a COVID-19 infection, and whether there are other factors that make someone more likely to contract COVID. -19 finish. with heart related problems, but they are not there yet.

“I think there have been many studies that have shown that the heart can be affected due to this infection. We just need to get more data and do more research to define how to identify that population where the heart is affected, “Rajpal said.” And then go ahead and figure out what the next step would be to minimize the danger, and move on from there.”

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