lystn

athlete heart covid
https://www.the-scientist.com/news-opinion/college-athletes-experienced-heart-damage-after-covid-19-study-67929
titiles like- “Images of the players’ hearts showed signs of inflammation consistent with myocarditis, a rare but potentially fatal condition.”
“two dozen of Ohio State University players using cardiac magnetic resonance (CMR), they found evidence of myocarditis in 15 percent, while a further 30 percent had cellular damage or swelling “

The Ny york times said-

https://www.nytimes.com/2020/09/16/well/move/is-coronavirus-affecting-the-hearts-of-college-athletes.html

Is Coronavirus Affecting the Hearts of College Athletes?

“In a new study of 26 college athletes who tested positive for coronavirus, four later showed signs of inflammation in their heart muscles.”

and my favorite-- CNN says
https://www.cnn.com/2020/09/14/health/covid-heart-inflammation-athletes-study/index.html
Covid-19 study suggests to screen recovering athletes for heart inflammation before they return to play

“As athletes recover from Covid-19, taking images of their hearts to screen for inflammation may help doctors determine when it could be safe to get back in the game, new research suggests.”


Now lets look at this paper and see if this paper says what you think it says or at least does it say what the Big Ten thinks it says!!

In the press release for the big ten return to football they say

“The Big Ten Council of Presidents and Chancellors (COP/C) adopted significant medical protocols including daily antigen testing, enhanced cardiac screening and an enhanced data-driven approach when making decisions about practice/competition. “
they go on to say
“All COVID-19 positive student-athletes will have to undergo comprehensive cardiac testing to include labs and biomarkers, ECG, Echocardiogram and a Cardiac MRI.”
The thing I find funny is they say things like ‘data-driven approach but then say things like ‘a positive athlete can not return for a minimum of 21 days’ and athletes must get a cardiac MRI along with a bunch of other non evidence based and non data driven recommendations. BUT this podcast is about the cardiac MRI in athletes so let's look at that paper and why it is dead fricken wrong!! This is a perfect example of why school presidents should play doctor and realistically speaking, I as a doctor don’t want to be a school president.

https://jamanetwork.com/journals/jamacardiology/fullarticle/2770645?guestAccessKey=ad3c4563-167f-452a-917f-7bfe15663b06&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=091120

The paper that has created this cardiac MRI craze is titled -
Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection
it was in jama cardiology on sept 11 and
they researchers at ohio state did CMR imaging in 26 competitive college athletes who previously had been diagnosed with COVID19.
and they found
“Four athletes (15%; all male individuals) had CMR findings consistent with myocarditis and Pericardial effusion was present in 2 athletes with CMR evidence of myocarditis.”

the authors conclusions,

“Cardiac magnetic resonance imaging has the potential to identify a high-risk cohort for adverse outcomes and may, importantly, risk stratify athletes for safe participation because CMR mapping techniques have a high negative predictive value to rule out myocarditis.4”
they go on to say
“cardiac magnetic resonance imaging evidence of myocardial inflammation has been associated with poor outcomes, including myocardial dysfunction and mortality.6 “

this sounds terrible!!! I will give you a second to grab a drink and sit down because I think in the
next several minutes you will be both relieved and frustrated about what this article really says.

music


this was first released by anish koka on twitter but she was spot on and this sort of information
needs widespread dissemination.

As I said there were 26 athletes but out of those 12 had mild symptoms DURING the infection
and 14 were asymptomatic during the infection.
None of these pts had chest pain or required hospitalization not even a slightly elevated troponin from
demand ischemia during their infection was reported and
per the paper, “There were no diagnostic ST/T wave changes on electrocardiogram, and
ventricular volumes and function were within the normal range”
now the current return to play protocol is all expert opinion but in the article is cited as 2-week not activity and if asymptomatic then no diagnostic cardiac testing but if symptomatic then an electrocardiogram and transthoracic echocardiogram.

The authors want you to look at this and say hey we might need to add CMRI

lots look at their logic

“Cardiac magnetic resonance imaging has the potential to identify a high-risk cohort for adverse outcomes and may, importantly, risk stratify athletes for safe participation because CMR mapping techniques have a high negative predictive value to rule out myocarditis.4”
https://www.sciencedirect.com/science/article/pii/S0735109718388430?via%3Dihub
and they site
Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations
which the opening line says
“This Journal of American College Cardiology Scientific Expert Panel provides
consensus recommendations for an update of the cardiovascular magnetic
resonance (CMR) diagnostic criteria for myocardial inflammation in patients with
suspected acute or active myocardial inflammation”

This is the first fault--remember these were healthy athlets THAT DID NOT HAVE SUSPECTED ACUTE OR ACTIVE MYOCARDIAL INFLMMATION!! you cant say well this test does really good at detecting a specific illness in this population so it must do a could job at detecting it in every population. That it like say well antibiotics work well to make people feel better when they have bacterial infections so they must work to make patients with cancer feel better. NO NO NO

next they said,

“Cardiac magnetic resonance imaging evidence of myocardial inflammation has been associated with poor outcomes, including myocardial dysfunction and mortality.6 “

and this comes from a paper titled “Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis.”

WITH SUSPECTED MYOCARDITIS!! this study was 670 patients who had CLINICALLY SUSPECTED myocarditis who then got a CMRI.
just to get in to that study you had to have one of the following
1) acute chest pain syndromes with symptom onset OR
2) signs of left ventricular (LV) dysfunction;
OR
3) subacute (onset ≥2 weeks) presentation of ventricular arrhythmias syncopal spells or abnormal ECG.


These athletes dont have chest pain, no increase trop., no signs of myocarditis, no change in EKG!!!!!

ONCE again you can’t use the results of a test in one population with a specific disease or condition and translate it to another population and expect it to do just as well!!

The pregnancy test seems to work well in women to let us know if they are pregnant or not. You can't take the accuracy of the pregnancy test in women and translate it to men!
In the studies that are cited for ‘badness’ patients have a bad clinical picture, it looks, talks, walks like myocarditis and CMRI is used to help validate these findings. In this current study used by the big ten the authors are taking athlete MRI findings INDEPENDENT of the symptoms and saying wait a second this looks like myocarditis even though it doesn't walk and talk like myocarditis. You can’t do this and you shouldn't do this….. imaging findings without a clinical picture is just an image.

let me give you my final thoughts before this ship sets sail into the ocean of evidence


still not sure what to think??

well on sept 15 the society of cardiac magnetic resonance release published an open letter and in
it the society said and I quote

“SCMR agrees that routine clinical use of cardiac MRI in asymptomatic patients with recent or prior
COVID19 infections is currently not justified based on recent preliminary scientific publications, and it
should not be recommended.”


with that I will leave you as I always leave you- with a reminder to question medicine so lets wait for the music