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College athletes who have recently recovered from COVID-19 infection show cardiac abnormalities on electrocardiography.

In a small study of ECGs on National Collegiate Athletic Association (NCAA) Division II athletes, those who had been infected with COVID-19 had a prolonged PR interval compared with matched athletes who had not been infected.

The study was presented at the 2021 Virtual American College of Sports Medicine (ACSM) Annual Meeting & World Congresses.

“The NCAA was requiring athletes to have an ECG for return to play after noting there could be some myocardial abnormalities following COVID-19 infection,” lead author Frank Wyatt, EdD, a sports physiologist and professor at Midwestern State University in Wichita Falls, Texas, told Medscape Medical News.

“Our head athletic trainer asked me if I could do ECGs on our COVID-19 recovered athletes, and I decided to do a matched pair design study to see how our infected and non-infected athletes compared,” Wyatt said.

Research in the general population has suggested that COVID-19 can cause damage not only to the lungs, but also to the myocardium, he said.

“Recent literature suggests COVID-19 is actually infusing itself into the cells of the myocardium and killing those cells, much the way it did in the lung, and possibly kidney and liver, so it’s going after those organs as well, not just the lungs.”

Wyatt presented results of ECGs that were done in seven COVID-infected athletes and in seven controls, who were free of infection.

The athletes’ recovery from COVID-19 infection was documented after two negative tests.

All subjects were matched by sport, gender, ethnicity, and anthropometry. Investigators obtained ECG recordings 2 to 4 weeks after the infected athletes had their recovery documented.

Study participants engaged in football, basketball, soccer, and volleyball, and Wyatt and his team were blinded as to their infected or control status.

Participants self-reported their ethnicity. Most were Caucasian or African American.

The main abnormality found was a prolonged PR interval. In the athletes who were recovered from COVID-19, the mean PR interval was 183.6 milliseconds [ms] (± 32.4 ms) compared with 141.7 ms (± 22.7 ms) among the controls.

Baseline ECGs for All Young Athletes?

Wyatt said he would like to see ECGs done at baseline as part of the physical exam NCAA athletes have to undergo at the start of each season. But that would be expensive.

“It has been suggested that they all need to have ECGs for baseline information, but they don’t do it because of money. If we had that baseline data on these athletes it would really give us a better picture of whether there was damage or not,” he said.

“At our small university, if I wasn’t available to do these ECGs, our athletic department would then have to go to the cardiologist to do them, and that is tremendously expensive. It has also been suggested that high school athletes get ECGs as a preliminary test when they start their season, and I think that is warranted as well as for the NCAA athletes, but because of the expense, they’re not doing it.”

Wyatt has continued to do ECGs on athletes who have survived COVID-19 and to date has ECG data on 70 athletes. He plans further comparisons between the infected and noninfected athletes.

“We want to see if we can solidify the results we presented at ACSM. We had small numbers, so our follow up is to see if we can statistically show in a more robust manner whether or not there was widespread abnormality in the athletes who got infected. They were only 2 to 4 weeks post-infected, and I don’t know what the long-term effects are going to be,” he said.

May Be an Important Finding

“This may be an important finding, but needs many more athletes, as there were only 7 in each group,” Curt J. Daniels, MD, director, Sports Cardiology Program and professor, Ohio State University Wexner Medical Center, Columbus, Ohio, commented to Medscape Medical News.

“Plus, it will need some imaging correlate and recovery ECGs to see if this effect of PR interval prolongation correlates with myocardial changes and whether it persists or resolves,” added Daniels, who was not part of the study.

“But I do find this interesting. …I agree we are looking for any ECG sign that might help tell us who needs a cardiac MRI. The Big Ten COVID-19 Cardiac Registry has 1597 ECGs on post COVID athletes we are analyzing, but preliminarily did not see any changes.”

Virtual 2021 ACSM Annual Meeting & World Congresses: Abstract # 1151. Presented June 1, 2021.

Wyatt and Daniels report no relevant financial relationships.

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