Background Myocarditis is a potential complication after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and a known cause of sudden cardiac death. Given the athletic demands of soldiers, identification of myocarditis and characterization of post-acute sequelae of SARS-CoV-2 infection with cardiovascular symptoms (CV PASC) may be critical to guide return-to-service. This study sought to evaluate the spectrum of cardiac involvement among soldiers with cardiopulmonary symptoms in the late convalescent phase of recovery from SARS-CoV-2 compared to a healthy soldier control group, and to determine the rate of progression to CV PASC. Methods All soldiers referred for cardiovascular magnetic resonance (CMR) imaging for cardiopulmonary symptoms following COVID-19 were enrolled and matched by age, gender, and athletic phenotype 1:1 to soldiers undergoing CMR in the year prior to the first case of COVID-19 at our institution. Demographic, clinical, laboratory, and imaging parameters were compared between groups. The diagnosis of acute myocarditis was made using modified Lake Louise criteria. Wilcoxon rank sum and chi-squared tests were used for comparison of continuous and categorical variables, respectively. Results Fifty soldier cases and 50 healthy soldier controls were included. The median time from SARS-CoV-2 detection to CMR was 71 days. The majority of cases experienced moderate symptoms (N = 43, 86%), while only 10% required hospitalization. The right ventricular (RV) ejection fraction (RVEF) was reduced in soldier cases compared to controls (51.0% vs. 53.2%, p = 0.012). Four cases were diagnosed with myocarditis (8%), 1 (2%) was diagnosed with Takotsubo cardiomyopathy, and 1 (2%) had new biventricular systolic dysfunction of unclear etiology. Isolated inferior RV septal insertion late gadolinium enhancement (LGE) was present in 8 cases and 8 controls (16% vs. 24%, p = 0.09). Seven of the 19 (37%) cases that completed an intermediate-term follow-up survey reported CV PASC at a median of 139 days of follow-up. Two of the 7 soldiers (29%) with CV PASC had a pathological clinical diagnosis (myocarditis) on CMR. Conclusions Cardiovascular pathology was diagnosed in 6 symptomatic soldiers (12%) after recovery from SARS-CoV-2, with myocarditis found in 4 (8%). RVEF was reduced in soldier cases compared to controls. CV PASC occurred in over one-third of soldiers surveyed, but did not occur in any soldiers with asymptomatic acute SARS-CoV-2 infection.
【저자키워드】 COVID-19, myocarditis, Athletes, Soldiers, Return-to-service, Sports Cardiology, 【초록키워드】 SARS-CoV-2, pathology, coronavirus, Hospitalization, SARS-COV-2 infection, Infection, Cardiopulmonary, Diagnosis, Gender, Symptom, progression, severe acute respiratory syndrome Coronavirus, Laboratory, cardiovascular, SARS-CoV-2 detection, Asymptomatic, myocarditis, symptomatic, Takotsubo cardiomyopathy, Control, death, phenotype, age, Follow-up, Soldiers, PASC, respiratory, etiology, demographic, Spectrum, Clinical diagnosis, Critical, moderate, Acute myocarditis, sudden cardiac death, criteria, moderate symptoms, imaging parameters, gadolinium, dysfunction, characterization, Cardiovascular Symptoms, acute respiratory syndrome, Ejection fraction, cardiac death, control group, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, median time, convalescent phase, return, acute SARS-CoV-2 infection, insertion, service, Chi-squared tests, parameter, Wilcoxon rank sum, controls, Result, enrolled, evaluate, occurred, healthy, reported, diagnosed, required, median, were used, majority, determine, occur, groups, Isolated, was reduced, 1:1, athletic, Lake, septal, variables, ventricular, 【제목키워드】 SARS-CoV-2, cardiovascular, symptomatic,