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

Background: Identification of athletes with cardiac inflammation following COVID-19 can prevent exercise fatalities. The efficacy of pre and post COVID-19 infection electrocardiograms (ECGs) for detecting athletes with myopericarditis has never been reported. We aimed to assess the prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players. Method(s): We conducted a multicentre study over a 2-year period involving 5 centres and 34 clubs and compared pre COVID and post COVID ECG changes in 455 consecutive athletes. ECGs were reported in accordance with the International recommendations for ECG interpretation in athletes. The following patterns were considered abnormal if they were not detected on the pre COVID-19 infection ECG: (a) biphasic T-waves;(b) reduction in T-wave amplitude by 50% in contiguous leads;(c) ST-segment depression;(d) J-point and ST-segment elevation >0.2 mV in the precordial leads and >0.1 mV in the limb leads;(e) tall T-waves >=1.0 mV (f) low QRS-amplitude in >3 limb leads and (g) complete right bundle branch block. Athletes exhibiting novel ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all 28 (6%) athletes, despite the absence of cardiac symptoms or ECG changes. Result(s): Athletes were aged 22+/-5 years (89% male and 57% white). 65 (14%) athletes reported cardiac symptoms. The mean duration of illness was 3+/-4 days. The post COVID ECG was performed 14+/-16 days following a positive PCR. 440 (97%) athletes had an unchanged post COVID- 19 ECG. Of these, 3 (0.6%) had cardiac symptoms and CMRs resulted in a diagnosis of pericarditis. 15 (3%) athletes demonstrated novel ECG changes following COVID-19 infection. Among athletes who demonstrated novel ECG changes, 10 (67%) reported cardiac symptoms. 13 (87%) athletes with novel ECG changes were diagnosed with inflammatory cardiac sequelae;pericarditis (n=6), healed myocarditis (n=3), definitive myocarditis (n=2), and possible/probable myocarditis (n=2). The overall prevalence of inflammatory cardiac sequelae based on novel ECG changes was 2.8%. None of the 28 (6%) athletes, who underwent a CMR, in the absence of cardiac symptoms or novel ECG changes revealed any abnormalities. Athletes revealing novel ECG changes, had a higher prevalence of cardiac symptoms (67% v 12% p<0.0001) and longer symptom duration (8+/-8 days v 2+/-4 days;p<0.0001) compared with athletes without novel ECG changes. Among athletes without cardiac symptoms, the additional yield of novel ECG changes to detect cardiac inflammation was 20% (n=3). Conclusion(s): 3% 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.

A pattern of respiratory dysfunction in mild cases of postCOVID-19 athletes: an emerging hypothesis

The purpose of this study was to investigate fitness indicators through cardiac stress test in post-COVID-19 athletes, who were not hospitalized, vs healthy ones. Forty male professional Greek soccer players, were divided into two groups: previously infected with COVID-19 and non-hospitalized (n=20, Age: 25.2+/-4.1 yrs, BSA: 1.9+/-0.2 m2, body fat: 11.8+/-3.4 %) vs. control (n=20, Age: 25.1+/-4.4 yrs, BSA: 2.0+/-0.3 m2, body fat: 10.8+/-4.5 %). Inclusion criteria were: age >=20-to-<=30 yrs, training age >=6 yrs, without recent injury (>12 months) and asymptomatic infected with COVID-19 (<7 days). For each athlete, prior to assessment cardiopulmonary function (CPF) were recorded body composition, spirometry and lactate blood level. Differences between groups were assessed with the independent samples t-test (<0.05). Several differences were detected between the two groups (COVID-19 vs. non-COVID-19 athletes, Table 1) during CPF. Results didn't showed differences between groups in VO2max (55.7+/-4.4 vs. 55.4+/-4.6 ml/min/kg Table 1. Results between groups (*p<0.05, #p<0.001) Post-COVID-19 athletes characterized by increased respiratory work at both rest and maximum effort as well as hyperventilation during exercise, which may explain increased metabolic needs and mechanical stress.

Niveles de Ansiedad Rasgo y Bienestar en jugadores de fútbol profesional de Chile durante la cuarentena por COVID-19 (Levels of Trait Anxiety and Well-being in Chilean professional soccer players during the COVID-19 quarantine)

In response to the emergence of COVID 19 and the resulting pandemic, countries took steps to manage infection curves. They have forced them to remain in confinement and this strategy affected various contexts, within which is the sports field, suspending competitions, official matches, training on the field, sports broadcasts, etc. However, in the case of soccer professionals, they remained in physical preparation through technological platforms. The objective of this work is to explore the levels of trait anxiety, feeling of well-being and the relationship between both variables in professional soccer players from four clubs in Chile in order to contribute to the diagnosis of how the Covid-19 crisis may have affected sports reality in terms of mental and emotional health. For this, the STAI and PERMA were applied. As results, the investigated soccer players show average levels of trait anxiety and a good level of general well-being. There is also a correlation between the two. This study allows us to conclude that although the current situation can be seen as threatening, maintaining working and active conditions for an athlete seems to be key to feeling a certain degree of control in the face of uncertainty, as well as coping strategies that allow having a high sensation of wellness. Alternate : En respuesta a la aparición del COVID 19 y la pandemia ocasionada, los países tomaron medidas para manejar las curvas de infección. Han obligado a permanecer en confinamiento y esta estrategia afectó a diversos contextos, dentro de los cuales, se encuentra el ámbito deportivo, suspendiendo competiciones, partidos oficiales, entrenamientos en cancha, transmisiones deportivas, etc. Sin embargo, en el caso de los profesionales del fútbol, se mantuvieron en preparación física a través de plataformas tecnológicas. El objetivo de este trabajo es explorar los niveles de ansiedad rasgo, de sensación de bienestar y la relación entre ambas variables en futbolistas profesionales de cuatro clubes de Chile con el fin de contribuir al diagnóstico sobre cómo la crisis de Covid-19 puede haber afectado a la realidad deportiva en cuanto a la salud mental y emocional. Para ello se aplicó el STAI y el PERMA. Como resultados, los futbolistas investigados muestran niveles promedio de ansiedad rasgo y buen nivel de bienestar general. También se encuentra correlación entre ambos. Este estudio permite concluir que si bien la situación actual puede verse como amenazante, mantener las condiciones laborales y en actividad para un deportista parece ser clave para sentir cierto grado de control frente a la incertidumbre, así como estrategias de afrontamiento que permitan tener una alta sensación de bienestar.Alternate :Em resposta ao surgimento do COVID 19 e à pandemia resultante, os países tomaram medidas para gerenciar as curvas de infecção. Obrigaram-nos a permanecer em confinamento e esta estratégia afetou vários contextos, entre os quais o campo desportivo, suspensão de competições, jogos oficiais, treinos em campo, transmissões desportivas, etc. No entanto, no caso dos profissionais de futebol, eles permaneceram na preparação física por meio de plataformas tecnológicas. O objetivo deste trabalho é explorar os níveis de ansiedade-traço, sensação de bem-estar e a relação entre ambas as variáveis ​​em jogadores profissionais de futebol de quatro clubes do Chile, a fim de contribuir para o diagnóstico de como a crise do Covid-19 pode ter afetou a realidade esportiva em termos de saúde mental e emocional. Para isso, foram aplicados o STAI e o PERMA. Como resultado, os jogadores de futebol investigados apresentam níveis médios de ansiedade-traço e um bom nível de bem-estar geral. Há também uma correlação entre os dois. Este estudo permite-nos concluir que embora a situação atual possa ser encarada como ameaçadora, a manutenção de condições laborais e ativas para um atleta parece ser fundamental para sentir um certo grau de controlo face à incerteza, bem como estratégias d coping que permitam uma alto senso de bem-estar.

British Cardiovascular Society Annual Conference, '100 years of Cardiology'

The proceedings contain 226 papers. The topics discussed include: mitral valve abnormalities in decedents of sudden cardiac death due to hypertrophic cardiomyopathy and idiopathic left ventricular hypertrophy;prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players;clinical outcomes and myocardial recovery in energetics, perfusion and contractile function after valve replacement surgery in severe aortic stenosis patients with diabetes comorbidity;brain phenotype of takotsubo syndrome;improving the diagnostic accuracy of apical hypertrophic cardiomyopathy;investigating a novel role for nesprin-1 and the linc complex in cardiomyocyte mechanotransduction;transcatheter aortic valve implantation in patients with right bundle branch block: should prophylactic pacing be undertaken?;and disease penetrance in asymptomatic carriers of familial cardiomyopathy variants.

Taking a Break from On-field Soccer Activity May be Beneficial to Collegiate Women Soccer Players

Introduction: A typical season for Canadian collegiate women soccer players consists of a pre-season training camp, in-season competitive games, and in-season practices. Over the course of a single season, players are exposed to a high number of subconcussive head impacts (1), which have been hypothesized to lead to cumulative brain trauma (2). Due to the COVID-19 pandemic, collegiate athletes in Canada did not have an inperson pre-season and off-season training was conducted virtually. Players experienced extended time off from the field and thus their training was less focused on soccer-specific training and more focused on fitness retention. The purpose of this study was to investigate the COVID-19 effect of playing time restrictions on brain function (using electroencephalography (EEG) and N-back-2), sleep, anxiety, and depression. Methods: Ten female collegiate soccer players were recruited. EEG, N-Back-2, Pittsburgh Sleep Quality Index (PSQI) and Sleep Condition Indicator (SCI), and the Hospital Anxiety and Depression Scale (HADS) were collected during both the 2019 and 2020 seasons (1-3). Average spectral power density was calculated across five frequency bands. Accuracy and reaction time were evaluated for the N-Back-2. PSQI, SCI and HADS scores were evaluated. Results: When comparing the end of the 2019 season and the beginning of the 2020 season, power analysis of the resting state EEG demonstrated a decrease in power spectral density across the delta, theta, and alpha frequency bands. There was a 9% increase in accuracy and a 3% decrease in reaction time using the N-Back-2. There was no change in sleep quality using the PSQI but a 6% change in sleep condition using the SCI. There was a 25% decrease in depression and a 19% decrease in anxiety. Discussion: This study is unique in our ability to access a significant time off in between two collegiate soccer seasons. Our pilot data suggests that there is an association between brain function, sleep and anxiety and depression after a stoppage in playing time. Varsity athletes are used to playing consistently over the course of their collegiate season, even playing through the summer. Additionally, on-filed practices and games expose players to a high number of subconcussive impacts. This pilot study sheds light on the potential benefit of providing collegiate athletes time off from on-field activities in between their collegiate seasons to fully recover from the strains of the season (4). Additionally, a switch in focus from on-field work to fitness-based activities may help alleviate athlete burnout and may boost overall stressors experienced by high-performance athletes (5,6). This is a preliminary pilot study and data analysis is ongoing. Further analyses will be conducted to better understand these relationships.

Neutralizing Antibody Responses to SARS-CoV-2 in Professional Soccer Players

Background. The Brazilian Football Confederation (CBF) protocol to control the spread of COVID-19 among professional soccer players is based on four cornerstone measures: (1) Tracing all symptomatic and asymptomatic COVID-19 cases by clinical monitoring and nasal swab SARS-CoV-2 RT-PCR testing up to 3 days before the soccer games;(2) Respiratory isolation of all SARS-CoV-2 positive players for at least 10 days, regardless symptoms;(3) All player with clinical suspicion of COVID-19 were immediately quarantined;(4) If a player became SARS-CoV-2 positive after the game, the other players were allowed to play the next game, if they remained asymptomatic and SARS-CoV-2 RT-PCR negative. Understanding how antibody responses to SARS-CoV-2 evolve can provide insights into therapeutic and testing approaches for COVID-19. In the present study we profile the antibody responses of players up to nine months from a SARS-CoV-2 positive RT-PCR test. Methods. Serum samples were obtained from 955 soccer players, and analyzed at the same laboratory in São Paulo city, in the Hospital Israelita Albert Einstein. It was used the cPas Technology, the sVNT kit for detecting and measuring circulating neutralizing antibodies against the SARS-CoV-2 virus. Results. Neutralizing antibody was positive for 416 samples (416/955=44%;C.I. 95%= [40%;47%]). From the 955 soccer players, 454 had RT-PCR+ previously, up to nine months until the neutralizing antibody tests. From this 454 players, 172 (38%) had neutralizing antibody below 20% (C.I. 95% = [34%;42%]), 30 (7%) between 20% and 30% (C.I. 95% = [5%;9%]), and e 252 (56%) above 30% (C.I. 95% =[51%;60%]). Antibody responses to SARS-CoV-2 were significantly higher in individuals RT-PCR+ (Table 1). There was no difference between the neutralizing antibody responses status to SARS-CoV-2 and the time between the RT-PCR+ and the neutralizing antibody test (p-value = 0.423;Figures 1 and 2, Table 2). Conclusion. This study found neutralizing activity of infection against SARSCoV-2 in 63% RT-PCR+ individuals, but only in 26% in RT-PCR(-) players. Level of neutralizing antibody responses maintained stable until up to nine months after a RT-PCR+.

Levels of Trait Anxiety and Well-being in Chilean professional soccer players during the COVID-19 quarantine

In response to the emergence of COVID 19 and the resulting pandemic, countries took steps to manage infection curves. They have forced them to remain in confinement and this strategy affected various contexts, within which is the sports field, suspending competitions, official matches, training on the field, sports broadcasts, etc. However, in the case of soccer professionals, they remained in physical preparation through technological platforms. The objective of this work is to explore the levels of trait anxiety, feeling of well-being and the relationship between both variables in professional soccer players from four clubs in Chile in order to contribute to the diagnosis of how the Covid-19 crisis may have affected sports reality in terms of mental and emotional health. For this, the STAI and PERMA were applied. As results, the investigated soccer players show average levels of trait anxiety and a good level of general well-being. There is also a correlation between the two. This study allows us to conclude that although the current situation can be seen as threatening, maintaining working and active conditions for an athlete seems to be key to feeling a certain degree of control in the face of uncertainty, as well as coping strategies that allow having a high sensation of wellness.