Cardiac Troponin Testing as a Component of Return to Play Cardiac Screening in Young Competitive Athletes Following SARS-CoV-2 Infection.
Nathaniel Moulson, Bradley J Petek, Timothy W Churchill, Jonathan A Drezner, Kimberly G Harmon, Stephanie A Kliethermes, Pranav Mellacheruvu, Manesh R Patel, Aaron L Baggish, ORCCA Investigators †
Author Information
Nathaniel Moulson: Division of Cardiology and Sports Cardiology BC University of British Columbia Vancouver British Columbia Canada.
Bradley J Petek: Division of Cardiology Massachusetts General Hospital Boston MA. ORCID
Timothy W Churchill: Division of Cardiology Massachusetts General Hospital Boston MA. ORCID
Jonathan A Drezner: Department of Family Medicine and Center for Sports Cardiology University of Washington Seattle WA. ORCID
Kimberly G Harmon: Department of Family Medicine and Center for Sports Cardiology University of Washington Seattle WA.
Stephanie A Kliethermes: Department of Orthopedics and Rehabilitation University of Wisconsin Madison WI. ORCID
Pranav Mellacheruvu: Elson S. Floyd College of MedicineWashington State University Spokane WA.
Manesh R Patel: Division of Cardiology Duke Heart Center, and Duke Clinical Research Institute Duke University School of Medicine Durham NC. ORCID
Aaron L Baggish: Division of Cardiology Massachusetts General Hospital Boston MA. ORCID
Background Initial protocols for return to play cardiac testing in young competitive athletes following SARS-CoV-2 infection recommended cardiac troponin (cTn) to screen for cardiac involvement. This study aimed to define the diagnostic yield of cTn in athletes undergoing cardiovascular testing following SARS-CoV-2 infection. Methods and Results This prospective, observational cohort study from ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) included collegiate athletes who underwent cTn testing as a component of return to play protocols following SARS-CoV-2 infection. The cTn values were stratified as undetectable, detectable but within normal limits, and abnormal (>99% percentile). The presence of probable or definite SARS-CoV-2 myocardial involvement was compared between those with normal versus abnormal cTn levels. A total of 3184/3685 (86%) athletes in the ORCCA database met the inclusion criteria for this study (age 20±1 years, 32% female athletes, 28% Black race). The median time from SARS-CoV-2 diagnosis to cTn testing was 13 days (interquartile range, 11, 18 days). The cTn levels were undetectable in 2942 athletes (92%), detectable but within normal limits in 210 athletes (7%), and abnormal in 32 athletes (1%). Of the 32 athletes with abnormal cTn testing, 19/32 (59%) underwent cardiac magnetic resonance imaging, 30/32 (94%) underwent transthoracic echocardiography, and 1/32 (3%) did not have cardiac imaging. One athlete with abnormal troponin met the criteria for definite or probable SARS-CoV-2 myocardial involvement. In the total cohort, 21/3184 (0.7%) had SARS-CoV-2 myocardial involvement, among whom 20/21 (95%) had normal troponin testing. Conclusions Abnormal cTn during routine return to play cardiac screening among competitive athletes following SARS-CoV-2 infection appears to have limited diagnostic utility.
