Rutgers Studies Myocarditis In COVID-Positive Big 10 Athletes

NEW BRUNSWICK, NJ — A newly published Rutgers study examined 1,597 Big Ten athletes who had COVID-19 in the past year, and found that 2.3 percent of them also developed myocarditis, which is inflammation of the heart muscles.

Rutgers examined the athletes using cardiac magnetic resonance (CMR) screening and found that most of the athletes who developed heart inflammation didn’t exhibit any symptoms: Of the 37 athletes diagnosed with myocarditis, 28 were asymptomatic.

This is the largest study of college athletes and comprehensive cardiac evaluation including cardiac MRIs.

The Rutgers study was published May 27 in JAMA Cardiology. Rutgers, a Division 1 school, is part of the Big Ten conference.

Myocarditis is the leading cause of sudden death in competitive athletes.

It is well known that COVID-19 causes heart inflammation and can even lead to permanent heart damage, as the muscles of the heart become scarred. Also, the the CDC is currently investigating whether the Pfizer and Moderna coronavirus vaccines cause heart inflammation. There have been multiple reports of people developing myocarditis and chest pain after getting those vaccines, including up to seven teenage boys in America who reported heart pain after getting the vaccine.

In September 2020, the Big Ten Conference mandated advanced testing for all COVID-19 positive athletes before they could return to play, citing studies that showed myocardial inflammation in patients who recovered from COVID-19.

The incidence of sudden cardiac death in college athletes has been estimated at one per 50,000 per year.

Myocarditis is usually caused by a viral infection and is more common in males than females.

The conference formed the Big Ten COVID-19 Cardiac Registry to gather scientific data to help establish guidelines on when players could safely resume playing sports.

Thirteen Big Ten universities agreed to share data with Rutgers about athletes with COVID-19 from March 1, 2020 to Dec. 15, 2020. The study focused on the results of athletes who had cardiac screenings, which included CMRs, electrocardiograms (electrical signal of the heartbeat), echocardiograms (an ultrasound of the heart) and blood tests to evaluate for myocardial inflammation or injury. Researchers found that CMR was highly effective at detecting both symptomatic and asymptomatic myocarditis as well as allowing athletes to immediately resume their sport if screenings were normal. With this protocol, 97.7 percent of the Big Ten athletes were cleared to return to exercise and competition.

“COVID-19 has presented us with many challenges as the infections seems to affect different people in different ways. Our athletes rely on a heavy work load from their cardiovascular system to excel at what they do. Knowing if COVID-19 infection could have affected an athlete's heart is of utmost importance to allowing these young men and women to compete safely,” said coauthor Jason Womack, chief of the Division of Sports Medicine and associate professor in the department of family medicine and community health at Rutgers Robert Wood Johnson Medical School. Womack is a Rutgers site co-principal investigator, along with Carrie Esopenko, assistant professor in the department of rehabilitation and movement science at Rutgers School of Health Professions, who was a coauthor of the study.

“This research will help lead the way to determine the best way to monitor our athletes after infection with COVID-19. If we can accurately identify the athletes that will develop myocarditis, we are taking large strides to preventing a severe adverse outcome when they resume athletic activity,” Womack said.

The next step is a core analysis of the data by experts from the Big Ten participating institutions who specialize in interpreting CMRs, echocardiograms and electrocardiograms, Womack said. This analysis can help better predict which athletes have cardiac abnormalities to standardize CMR protocols and interpretation and determine when athletes can safely return to play.

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