Universität zu Köln

Diebold, Katharina Felicitas (2023). Mid- to long-term cardiac magnetic resonance findings in elite athletes recovered from COVID-19: results from an ongoing observational COVID-19 study at a German Olympic medical centre. PhD thesis, Universität zu Köln.

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Abstract

INTRODUCTION: The cardiac magnetic resonance (CMR) data on mid- to long-term myocardial damage due to COVID-19 infections in elite athletes are scarce. There-fore, this study investigated the mid -to long-term conse-quences of myocardial involvement after a COVID-19 in-fection in elite athletes. MATERIALS AND METHODS: This study included 27 ath-letes at the German Olympic Centre North Rhine-West-phalia (NRW)/Rhineland with a confirmed previous COVID-19 infection between January 2020 and October 2021. The athletes were part of an ongoing observational COVID-19 study at the Institute of Cardiology and Sports Medicine Cologne at the German Sport University (DSHS).Nine healthy non-athletes with no prior COVID-19 illness served as controls. CMR was performed within a mean of 182 days (standard deviation [SD] 99) of the ini-tial positive test result. RESULTS: CMR did not reveal any signs of acute my-ocarditis (according to the current Lake Louise criteria) or myocardial damage in any of the 26 elite athletes with pre-vious COVID-19 infection. Of these athletes, 92% expe-rienced a symptomatic course, and 54% reported symp-toms lasting for more than 4 weeks. One male athlete was excluded from the analysis because CMR revealed an arrhythmogenic right ventricular cardiomyopathy (ARVC). Athletes had significantly enlarged left and right ventricle volumes and increased left ventricular myocardial mass in comparison to the healthy control group (LVEDVi 103.4 vs. 91.1 ml/m2, p = 0.031; RVEDVi 104.1 vs 86.6 ml/m2, p = 0.007; LVMi 59.0 vs 46.2 g/m2, p = 0.002). Only two cases of elevated high-sensitivity-Troponin were documented; in one, the participant had previously engaged in high-inten-sity training, and in the other, CMR revealed a diagnosis of an arrhythmogenic cardiomyopathy. CONCLUSION: Our findings suggest that the risk for mid-to long-term myocardial damage is very low to negligible in elite athletes. Our results do not allow conclusions to be drawn regarding myocardial injury in the acute phase of in-fection nor about possible long-term myocardial effects in the general population.

Item Type:	Thesis (PhD thesis)
Translated title:	Title Language Mittel- bis langfristige kardiale Magnetresonanzbefunde bei Spitzensportlern, die sich von COVID-19 erholt haben: Ergebnisse einer laufenden Beobachtungsstudie zu COVID-19 in einem deutschen olympischen medizinischen Zentrum German
Translated abstract:	Abstract Language Einleitung: Die Daten aus der kardialen Magnetresonanztomographie (CMR) zu mittel- bis langfristigen Myokardschäden infolge von COVID-19-Infektionen bei Spitzensportler:innen sind bislang begrenzt. Ziel dieser Studie war es daher, die mittel- bis langfristigen Folgen einer myokardialen Beteiligung nach einer COVID-19-Infektion bei Spitzensportler:innen zu untersuchen. Material und Methoden: In die Studie wurden 27 Athlet:innen des Olympiastützpunkts Nordrhein-Westfalen (NRW)/Rheinland mit einer zwischen Januar 2020 und Oktober 2021 bestätigten COVID-19-Infektion eingeschlossen. Die Athlet:innen waren Teil einer laufenden Beobachtungsstudie zu COVID-19 am Institut für Kardiologie und Sportmedizin der Deutschen Sporthochschule Köln. Neun gesunde Nicht-Sportler:innen ohne vorherige COVID-19-Erkrankung dienten als Kontrollgruppe. Die CMR-Untersuchung erfolgte im Mittel 182 Tage (Standardabweichung [SD] 99) nach dem ersten positiven Testergebnis. Ergebnisse: Bei keinem der 26 Spitzensportler:innen mit durchgemachter COVID-19-Infektion zeigten sich in der CMR Hinweise auf eine akute Myokarditis (gemäß den aktuellen Lake-Louise-Kriterien) oder eine Myokardschädigung. Von diesen Athlet:innen hatten 92 % einen symptomatischen Verlauf, und 54 % berichteten über Symptome, die länger als vier Wochen anhielten. Ein männlicher Athlet wurde von der Analyse ausgeschlossen, da die CMR eine arrhythmogene rechtsventrikuläre Kardiomyopathie (ARVC) nachwies. Im Vergleich zur gesunden Kontrollgruppe wiesen die Athlet:innen signifikant vergrößerte links- und rechtsventrikuläre Volumina sowie eine erhöhte linksventrikuläre Myokardmasse auf (LVEDVi 103,4 vs. 91,1 ml/m², p = 0,031; RVEDVi 104,1 vs. 86,6 ml/m², p = 0,007; LVMi 59,0 vs. 46,2 g/m², p = 0,002). Nur in zwei Fällen wurden erhöhte High-sensitivity-Troponin-Werte dokumentiert; bei einer Person nach hochintensivem Training und bei der anderen wies die CMR eine arrhythmogene Kardiomyopathie nach. Schlussfolgerung: Unsere Ergebnisse legen nahe, dass das Risiko für mittel- bis langfristige Myokardschäden bei Spitzensportler:innen sehr gering bis vernachlässigbar ist. Allerdings erlauben die Daten keine Rückschlüsse auf mögliche myokardiale Schäden in der akuten Infektionsphase oder auf langfristige kardiale Folgen in der Allgemeinbevölkerung. German
Creators:	Creators Email ORCID ORCID Put Code Diebold, Katharina Felicitas diebold95@icloud.com UNSPECIFIED UNSPECIFIED
Contributors:	Contribution Name Email Author in quotations or text extracts Schneeweis, Christopher christopher.schneeweis@googlemail.com Author in quotations or text extracts Schramm, Thomas schramm@kardiologie-rodenkirchen.de Author in quotations or text extracts Syrek, Christine ch.syrek@gmail.com Author in quotations or text extracts Predel, Hans Georg Predel@dshs-koeln.de Author in quotations or text extracts Manka, Robert Robert.Manka@usz.ch Author in quotations or text extracts Zacher, Jonas j.zacher@dshs-koeln.de Author in quotations or text extracts UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-789546
DOI:	10.57187/s.3534
Date:	15 December 2023
Place of Publication:	Swiss Medical Weekl
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Innere Medizin > Klinik III für Innere Medizin - Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin
Subjects:	Natural sciences and mathematics Medical sciences Medicine Athletic and outdoor sports and games
Uncontrolled Keywords:	Keywords Language Cardiac magnetic resonance (CMR) English Elite athletes English COVID-19 English
Date of oral exam:	30 June 2025
Referee:	Name Academic Title Reuter, Hannes Professor Dr. Bunck, Alexander Professor Dr.
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Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/78954