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

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 efects 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 signifcantly higher in the COVID19-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 signifcantly 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 signifcant diferences for any of the comparisons were found for circumferential or radial strain.
Discussion The signifcantly elevated values in the COVID-19-cohort at T0 may be due to an afectation 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 efect on cardiac health in athletes after a COVID-19-infection in
this trial.