Subacute and long-term effects of COVID-19 on cardiac health and function in German elite athletes assessed by strain analysis: a speckle tracking echocardiography observational trial

Abstract Introduction During the COVID-19-pandemic, most elite athletes were infected with the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Initial worries of high rates of multi-organ complications including the heart and ending sporting careers were disproved by large studies. However, the effects of COVID-19 on the heart and its function in elite athletes remains unclear, especially in the prolonged post-infection follow-up and during and after return to competition. Methods In the year 2020, a cohort of 127 elite athletes (boasting an accumulated 58 Olympic and world championship medals) was recruited, 76 of them recently having undergone a SARS-CoV-2 infection. Echocardiography was conducted 1 (T0), 5 (T1) and 9 (T2) months after the infection in the infected cohort and at baseline for the control cohort. Left-ventricular global longitudinal, circumferential, and radial strain was compared cross-sectionally at baseline between athletes after a COVID-19-infection and control athletes, as well as longitudinally in the COVID-19-cohort. Results At baseline, global longitudinal strain (reported as absolute %-values) was significantly higher in the COVID-19-cohort in comparison to control-cohort (20.37 ± 1.98% vs. 19.41 ± 2.11%, respectively, p = 0.042). In the longitudinal assessment within the COVID-19-cohort the global longitudinal strain was significantly higher shortly after the infection (T0) than at the two follow-up measurements (T0: 20.37 ± 1.98%; T1: 19.34 ± 1.65%; T2: 19.30 ± 1.68% ( p = 0.0052 and p = 0.0044, respectively)). No significant differences for any of the comparisons were found for circumferential or radial strain. Discussion The significantly elevated values in the COVID-19-cohort at T0 may be due to an affectation of the autonomic nervous system, which has previously been documented as a result of COVID-19-disease. No cardiac injury after COVID-19 was detected using strain analysis. All documented global longitudinal strain values were within the normal range for athletes. A return to training and competition had no deleterious effect on cardiac health in athletes after a COVID-19-infection in this trial.