Exploring the relationship between physical activity and covid-19 infection in a young, non-hospitalized cohort in the united kingdom

201 Table 1Demographics of cohortVariableCategory/SummaryNegativePositiveOverallORP-value95%CI low95%CI high3043(79.7%)777(20.3%)3820AgeMean/SD21.19/6.7920.93/6.0721.12/6.640.9800.2580.9451.015Median (Q1-Q3)18(15, 27)19(16, 25)18(15, 27)Min-Max14-3614-3614-36BMIMean/SD23.34/4.8924.12/4.9023.48/4.831.068<.0011.0351.103Median (Q1-Q3)22.44(19.9, 25.9)23.39(20.5, 26.8)22.60(20.06, 26.03)Min-Max13.36-55.2514.40-45.9013.36-55.25SexWomen1107(36.3%)250(32.4%)1357 (35.5%)1Men1935 (63.5%)521(67.6%)2456 (64.3%)1.2020.0321.0161.421EthnicityWhite2789(91.65%)707(90.99%)3496(91.5%)Asian89(2.92%)23(2.96%)112 (2.93%)Black53(1.74%)11(1.42%)64 (1.68%)Other112(3.68%)36(4.63%)148 (3.87%)BAME vs. White1.0870.5550.8241.434Group Sedentary495(16.24%)112(14.53%)607 (15.89%)1typeRecreational1331(43.67%)302(39.17%)1633 (42.76%)0.7720.0030.6500.916Elite1222(40.09%)357(46.30%)1579 (41.35%)0.7620.0240.6020.965MET A (0 METs)440 (14.44%)105(13.62%)545(14.27%)1CategoryB (<500 MET-min/week)91(2.99%)12(1.56%)103 (2.70%)0.5540.0700.2921 049C (500-999 MET-min/week)128(4.20%)25(3.24%)153 (4.01%)0.8200.4170.5081.324D (1000-1499 MET-min/week)149(4.89%)37(4.80%)186 (4.87%)1.0780.7220.7121.633E (>1500MET-min/week)2240(73.49%)592(76.78%)2832 (74.16%)1.1220.3300.8901.414 201 Table 2The effects of demographics, physical activity, and symptoms on disease durationORp-value95%CI low95%CI highMen vs. Women0.561<0.0010.4180.753MET categoriesCATEGORY B vs. A1.4360.5490.4414.679CATEGORY C vs. A0.8650.7430.3642.056CATEGORY D vs. A0.5440.0890.2691.098CATEGORY E vs. A0.5320.0020.3560.795Recreational vs. Elite athlete1.698<0.0011.2602.288Sedentary vs. Elite athlete2.255<0.0011.4913.411Sedentary vs. recreational1.3280.185.8732.019Shortness of breath (YES vs. NO)3.558<0.0012.6144.842Chest pain (YES vs. NO)2.341<0.0011.5093.630Chest tightness (YES vs. NO)2.733<0.0011.9143.902Palpitations (YES vs. NO)3.1370.0011.5616.305 201 Figure 1The effect of the available variables on the duration of the disease in COVID-19 positive participants[Figure omitted. See PDF]Conflict of InterestNone

Prevalence and diagnostic significance of de-novo 12-lead ECG changes after COVID-19 infection in elite soccer players.

BACKGROUND AND AIM: The efficacy of pre-COVID-19 and post-COVID-19 infection 12-lead ECGs for identifying athletes with myopericarditis has never been reported. We aimed to assess the prevalence and significance of de-novo ECG changes following COVID-19 infection. METHODS: In this multicentre observational study, between March 2020 and May 2022, we evaluated consecutive athletes with COVID-19 infection. Athletes exhibiting de-novo ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all players (n=30) following COVID-19 infection, despite the absence of cardiac symptoms or de-novo ECG changes. RESULTS: 511 soccer players (median age 21 years, IQR 18-26 years) were included. 17 (3%) athletes demonstrated de-novo ECG changes, which included reduction in T-wave amplitude in the inferior and lateral leads (n=5), inferior leads (n=4) and lateral leads (n=4); inferior T-wave inversion (n=7); and ST-segment depression (n=2). 15 (88%) athletes with de-novo ECG changes revealed evidence of inflammatory cardiac sequelae. All 30 athletes who underwent a mandatory CMR scan had normal findings. Athletes revealing de-novo ECG changes had a higher prevalence of cardiac symptoms (71% vs 12%, p<0.0001) and longer median symptom duration (5 days, IQR 3-10) compared with athletes without de-novo ECG changes (2 days, IQR 1-3, p<0.001). Among athletes without cardiac symptoms, the additional yield of de-novo ECG changes to detect cardiac inflammation was 20%. CONCLUSIONS: 3% of athletes demonstrated de-novo ECG changes post COVID-19 infection, of which 88% were diagnosed with cardiac inflammation. Most affected athletes exhibited cardiac symptoms; however, de-novo ECG changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.

Prevalence and diagnostic significance of novel 12-lead ecg patterns following COVID-19 infection in elite soccer players

2 Table 1Clinical Characteristics and CMR and 31P-MRS findings HV n=15 Isolated AS n=63 Diabetes and AS n=25 P value Age, y 71±4 71±12 72±7 0.73 Female, n (%) 6(40) 7(28) 25(40) 0.3 BMI, kg/m2 26±2* 27±4€ 31±4 <0.0001 Systolic BP, mmHg 136±9 132±17 131±20 0.44 HbA1c, mmol/mol 37±3* 37±4€ 56±14 <0.0001 NT- proBNP, ng/L 67[21-112] * 1411[629-2194]† 1376[390-2362] <0.0001 Euro Score II - 1.13 1.14 0.27 Rockwood Score - 2.15 2.22 0.23 CARDIAC STRUCTURAL AND FUNCTIONAL CHANGES LV end-diastolic volume indexed to BSA, mL/m2 78±15 80±22 84±21 0.53 LV end-systolic volume indexed to BSA, ml/m2 28±6 32±22 35±19 0.24 LV mass, g 102±25* 147±41† 164±59 0.0003 LV mass to LV end-diastolic volume, g/mL 0.66±0.11* 0.99±0.26† 0.96±0.25 <0.0001 LV stroke volume, ml 95±22 94±22 100±20 0.42 LV ejection fraction,% 64±3 64±12 60±12 0.25 LV maximal wall thickness, mm 10±1* 14±3† 14±3 <0.0001 RV end-diastolic volume indexed to BSA, mL/m2 83±12 79±18 78±20 0.36 RV end-systolic volume indexed to BSA, ml/m2 32±7 37±14 37±16 0.6 RV stroke volume, ml 97±17† 82±20 84±22 0.03 RV ejection fraction,% 62±5* 55±9† 54±10 0.01 LA biplane end-systolic volumes, mL 72±20 95±50 100±44 0.16 Biplane LA EF,% 59±11* 45±17 39±19 0.008 Global longitudinal strain, (-),% 16±4* 13±4† 11±4 0.001 Peak systolic circumferential strain, (-),% 21±2 1 ±5 18±5 0.11 Peak longitudinal diastolic strain rate, s-1 0.79±0.2 0.83±0.3 0.65±0.2€ 0.04 Mean native T1, (ms) 1209±79 1232±88 1262±84 0.16 Extra cellular volume, (%) 24±3 24±2 25±4 0.54 LGE, (%) - 3.1±2 3.4±4 0.85 MYOCARDIAL ENERGETICS AND PERFUSION PCr/ATP ratio 2.17±0.5* 1.74±0.4† 1.39±0.25€ <0.0001 Increase in RPP,% 25 23 25 0.5 Stress MBF, ml/min/g 2.14±0.66* 1.68±0.6† 1.24±0.3€ <0.0001 Rest MBF, ml/min/g 0.66±0.11 0.73±0.2 0.68±0.22 0.4 MPR 3.83±1.8* 2.4±0.78† 1.78±0.47€ <0.0001 € signifies p<0.05 between AS DM and AS Control, * signifies p<0.05 between AS DM and HV, † signifies p≤0.05 between AS Control and HV.Values are mean ±standard deviations or percentages. BSA indicates body surface area;LV, Left ventricle;RV, right ventricle;DM, type 2 diabetes mellitus;HCM, hypertrophic cardiomyopathy;LV, left ventricular;LA, left atrial;LA EF, left atrial ejection fraction;PCr, phosphocreatine;ATP, adenosine tri-phosphate;RPP, rate pressure product;MBF, myocardial blood flow;MPR, myocardial perfusion reserve. 2 Figure 1Cumulative incidence of the clinical events after valve replacement (AVR) is shown in the top row. Differences in myocardial PCr/ATP ratio, global stress myocardial blood flow and global longitudinal strain between healthy volunteers, patients with isolated severe AS and patients with severe AS and DM before the AVR in PCr/ATP ratio;global stress myocardial blood flow (ml/min/g) and global longitudinal strain are shown in the middle row. Changes in energetics, stress MBF and GLS after AVR are shown in the bottom row.[Figure omitted. See PDF]Conclusion3% of elite soccer players demonstrated novel ECG changes post COVID-19 infection, of which almost 90% were diagnosed with cardiac inflammation during subsequent investigation. Most athletes with novel ECG changes exhibited cardiac symptoms. Novel ECGs changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.Conflict of InterestNone

The effect of concomitant COVID-19 infection on outcomes in patients hospitalized with heart failure.

AIMS: Patients with cardiovascular disease appear particularly susceptible to severe COVID-19 disease, but the impact of COVID-19 infection on patients with heart failure (HF) is not known. This study aimed to quantify the impact of COVID-19 infection on mortality in hospitalized patients known to have HF. METHODS AND RESULTS: We undertook a retrospective analysis of all patients admitted with a pre-existing diagnosis of HF between 1 March and 6 May 2020 to our unit. We assessed the impact of concomitant COVID-19 infection on in-hospital mortality, incidence of acute kidney injury, and myocardial injury. One hundred and thirty-four HF patients were hospitalized, 40 (29.9%) with concomitant COVID-19 infection. Those with COVID-19 infection had a significantly increased in-hospital mortality {50.0% vs. 10.6%; relative risk [RR] 4.70 [95% confidence interval (CI) 2.42-9.12], P < 0.001} and were more likely to develop acute kidney injury [45% vs. 24.5%; RR 1.84 (95% CI 1.12-3.01), P = 0.02], have evidence of myocardial injury [57.5% vs. 31.9%; RR 1.81 (95% CI 1.21-2.68), P < 0.01], and be treated for a superadded bacterial infection [55% vs. 32.5%; RR 1.67 (95% CI 1.12-2.49), P = 0.01]. CONCLUSIONS: Patients with HF admitted to hospital with concomitant COVID-19 infection have a very poor prognosis. This study highlights the need to regard patients with HF as a high-risk group to be shielded to reduce the risks of COVID-19 infection.