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

ABSTRACT

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