COVID-19: the Risk to Athletes.

PURPOSE OF REVIEW: The COVID-19 pandemic has had a profound impact on athletics, and the question of safely resuming competitive sports at all levels has been a source of significant debate. Concerns regarding myocarditis and the risk of arrhythmias and sudden death in athletes have prompted heightened attention to the role of cardiovascular screening. In this review, we aim to comprehensively outline the cardiovascular manifestations associated with COVID-19 infection, to discuss screening, diagnosis, and treatment strategies, and to evaluate the current literature on the risk to athletes and recommendations regarding return-to-play. RECENT FINDINGS: COVID-19 is known to cause myocarditis, with presentations ranging from subclinical current or prior infection detected on cardiac MRI imaging, to fulminant heart failure and shock. While initial data early in the pandemic suggested that the risk of myocarditis could be significant even in patients with nonsevere COVID-19 infection, recent studies suggest a very low prevalence of clinically significant disease in young athletes. SUMMARY: While COVID-19 can have significant cardiovascular manifestations, recent data demonstrate that a screening approach guided by severity of COVID-19 infection and cardiovascular symptoms allows the majority of athletes to safely return to play in a timely manner. We must continue to tailor our approach to screening athletes as knowledge grows, and further research on the longitudinal cardiovascular effects of COVID-19 is needed.

Clinical status and cardiovascular risk profile of adults with a history of juvenile dermatomyositis.

OBJECTIVE: A pilot study of adults who had onset of juvenile dermatomyositis (JDM) in childhood, before current therapeutic approaches, to characterize JDM symptoms and subclinical cardiovascular disease. STUDY DESIGN: Eight adults who had JDM assessed for disease activity and 8 healthy adults (cardiovascular disease controls) were tested for carotid intima media thickness and brachial arterial reactivity. Adults who had JDM and 16 age-, sex-, and body mass index-matched healthy metabolic controls were evaluated for body composition, blood pressure, fasting glucose, lipids, insulin resistance, leptin, adiponectin, proinflammatory oxidized high-density lipoprotein (HDL), and nail-fold capillary end row loops. RESULTS: Adults with a history of JDM, median age 38 years (24-44 years) enrolled a median 29 years (9-38 years) after disease onset, had elevated disease activity scores, skin (7/8), muscle (4/8), and creatine phosphokinase (2/8). Compared with cardiovascular disease controls, adults who had JDM were younger, had lower body mass index and HDL cholesterol (P = .002), and increased intima media thickness (P = .015) and their brachial arterial reactivity suggested impairment of endothelial cell function. Compared with metabolic controls, adults who had JDM had higher systolic and diastolic blood pressure, P = .048, P = .002, respectively; lower adiponectin (P = .03); less upper arm fat (P = .008); HDL associated with end row loops loss (r = -0.838, P = .009); and increased proinflammatory oxidized HDL (P = .0037). CONCLUSION: Adults who had JDM, 29 years after disease onset, had progressive disease and increased cardiovascular risk factors.

Frequency and significance of acute heart failure following liver transplantation.

Reversible cardiomyopathy has been reported in patients after liver transplantation. However, there are few data on the incidence, risk factors, and prognosis of this condition. Liver transplantation recipients who underwent preoperative right- and left-sided cardiac catheterization as well as preoperative transthoracic echocardiography from 2001 to 2005 were identified. Eighty-six patients met the outlined criteria and were included in the study. The incidence of severe heart failure (HF) after transplantation in this population was 6 of 86 (approximately 7%). Patients who developed HF were slightly older (mean age 61.2 +/- 8.9 vs 55.4 +/- 9.2 years, p = 0.08) but had similar preoperative ejection fractions (60 +/- 5% vs 57 +/- 8%, p = 0.22) and comparable systemic arterial blood pressure (116 +/- 22/62 +/- 11 vs 127 +/- 9/66 +/- 9, p >0.1). In addition, the severity of liver disease as measured by the model for end-stage liver disease score was not different between the 2 groups (23.9 +/- 9.7 vs 26 +/- 10.7, p = 0.5). There was also no significant difference in the preoperative cardiac index (3.8 +/- 1 vs 3.6 +/- 1.5 L/min/m2, p = 0.9) or pulmonary artery wedge pressure (13.6 +/- 5.8 vs 15.3 +/- 2.8 mm Hg, p = 0.42). The incidence of alcohol use as the presumed cause of liver failure was equivalent in the 2 groups (33% vs 25%, p = 0.65). The patients who developed HF did have significantly higher preoperative mean pulmonary arterial systolic pressures (43 +/- 10 vs 30 +/- 9 mm Hg, p = 0.02) and right ventricular systolic pressures (44 +/- 13 vs 34 +/- 8 mm Hg, p = 0.05). In conclusion, severe systolic HF may occur after liver transplantation in patients without traditional risk factors for HF. This study suggests that those patients with preoperative elevated right-sided cardiac pressures, as well as older patients, may be at excess risk for developing HF after transplantation.

Elevated B-type natriuretic peptide in asymptomatic men with chronic aortic regurgitation and preserved left ventricular systolic function.

Serum B-type natriuretic peptide (BNP) levels reflect myocardial strain and are known to be elevated in patients with heart failure. To determine if BNP levels are elevated in patients with aortic regurgitation, we measured BNP levels in patients with chronic asymptomatic aortic regurgitation and normal left ventricular systolic function.

Evidence-based treatment of lipids in the elderly.

The elderly (men aged 65 years and older and women aged 75 years and older) constitute a population at high absolute risk for the morbidity and mortality of atherosclerotic cardiovascular disease. Statins have been shown in multiple large trials to reduce the burden of atherosclerotic disease in both middle-aged and elderly patients at elevated risk for coronary events, stroke, and death. We reviewed the major statin trials with particular emphasis on the significant number of elderly subjects. The impact of statins on the elderly, both positive and negative, is tabulated. In addition, we briefly discuss risk assessment in the elderly because selection of elderly patients for intensive low-density lipoprotein cholesterol reduction with statins requires clinical judgment that must weigh the need for subclinical measures of atherosclerosis. We also consider negative aspects, risks, and costs of such therapy.