Resuming Training in High-Level Athletes After Mild COVID-19 Infection: A Multicenter Prospective Study (ASCCOVID-19)

Laurent Chevalier (1) , Hubert Cochet (2, 3) , Saagar Mahida (2, 4) , Sylvain Blanchard S. (5) , Antoine Benard (3) , Tanguy Cariou (3) , Soumaya Sridi-Cheniti (3, 6) , Samy Benhenda (3, 6) , Stephane Doutreleau (7, 8) , Stephane Cade (9) , Sylvain Guerard , Jean-Michel Guy (3) , Pascale Trimoulet (3) , Stephane Picard (3) , Bernard Dusfour (5) , Aurelie Pouzet (3) , Stephanie Roseng (2, 3) , Marco Franchi (6) , Pierre Jais (2, 3) , Isabelle Pellegrin (10, 3)

1 Clinique du sport de Bordeaux-Mérignac
2 IHU-LIRYC
3 CHU Bordeaux
4 LH&CH - Liverpool Heart and Chest Hospital NHS Trust [UK]
5 Commission médicale Ligue Nationale de Rugby
6 UB - Université de Bordeaux
7 HP2 - Hypoxie et PhysioPathologie
8 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
9 Clinique du Millénaire - Oc Santé [Montpellier]
10 ImmunoConcept - Immunology from Concept and Experiments to Translation

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: 285/950 athletes (30.0%) had mild/asymptomatic COVID-19 [79 (8.3%) at inclusion (COVID(+)(prevalent)); 206 (28.3%) during follow-up (COVID(+)(incident))]. 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).

Mots clés: Sport; SARS-CoV-2; ECG; Echocardiography; Stress test; Cardiac MRI

Domaines: Maladies infectieuses; Maladies émergentes; Cardiologie et système cardiovasculaire; Physiologie [q-bio.TO]; Santé publique et épidémiologie

Laurent Chevalier, Hubert Cochet, Saagar Mahida, Sylvain Blanchard S., Antoine Benard, et al.. Resuming Training in High-Level Athletes After Mild COVID-19 Infection: A Multicenter Prospective Study (ASCCOVID-19). Sports medicine - Open, 2022, 8, pp.83. ⟨10.1186/s40798-022-00469-0⟩. ⟨hal-03724417⟩