Seattle Childrens Pediatric Cardiology Safe Return to competition after covid19 infection OBJECTIVES Why the concern for athletes after COVID19 What is the still missing information A proposed algorithm based upon the known information ID: 915743
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Slide1
Cory V. Noel, MDPediatric Cardiology of AlaskaSeattle Children’s Pediatric Cardiology
Safe Return to competition after covid-19 infection
Slide2OBJECTIVES
Why the concern for athletes after COVID-19?
What is the
still missing
information?
A proposed algorithm based upon the known information
Slide3Why the concern in athletes?
Slide4Why the concern in athletes?
Siripanthong
B, et al.,
Heart Rhythm; 2020 Vol 17; No 9.
Slide5Why the concern in athletes?
Pirzada A, et al., CJC; 2020;05.005
Myocardial injury is relatively common in COVID-19
Accounting for 7-23%
Associated with higher morbidity and mortality
Slide6Why the concern in athletes?
Guzik T, et al., European Society of Cardiology; 2020; 10.1093/cvr/cvaa106
Myocarditis typically occurred after a prolonged period (10-15 days) following symptom onset
Slide7What is the missing information?
Niaz T, et al.,
Pediatric Cardiology; 2020; 10.1007/s00246-020-02476-y.
Slide8What is the missing information?
What is the incidence of myocardial involvement in asymptomatic people?
What is
the incidence of myocardial involvement in
teenagers?
What is the incidence of myocardial involvement in
asymptomatic to mildly symptomatic teenagers
?
Slide9Cardiac involvement in covid-19
If present, what is primary concern of myocardial involvement?
What is clinical presentation of myocarditis following other viral infections?
Slide10Myocarditis & Sudden Cardiac Arrest
Harmon KG, et
al.
Mayo
Clin
Proc
. 2016;91(11):1493-1502
Slide11Variable causes of SCA
Ackerman M, et
al.
Circulation
. 2016;133:1006-1026
Slide12Variable causes of SCA
Ackerman M, et al. Circulation
. 2016;133:1006-1026
Slide13myocarditis
Pollack A, et al., Nat Rev Cardiol.,2015 12 670-689.
Slide14Myocarditis clinical presentation
Ali-Ahmed F., et al., Curriculum in Cardiology
2019.08.007
Slide15Myocarditis diagnostic algorithm
Eichorn C., et al., JACC: Cardiovascular Imaging
2019; 19 (2)494-507
Slide16Myocarditis ecg
abnormalities
Eichorn
C., et al., JACC: Cardiovascular Imaging 2019; 19 (2)494-507
Slide17Myocarditis ecg
abnormalities
Deluigi
C.C., et al., International Journal of Cardiology; 2013 165, 100-106.
Slide18Myocarditis ecg
abnormalities
Deluigi
C.C., et al., International Journal of Cardiology; 2013 165, 100-106.
Slide19Lake Louis Criteria
Slide20Lake Louise criteria comprised of increased signal on T2-weighted images, EGE ratio, and LGE
Lake louis criteria
Slide21Lake louis criteria
Banka P, et al., JCMR, 2015
13 centers, 143 patients, clinical diagnosis
LGE: 100% Abnormal in 81%
T2W: 69% Abnormal in 81%
EGE: 29% Abnormal in 55%
FPP: 48% Abnormal in 8%
LV EDV, LVEF, RVEF predictive of persistent dysfunction
Slide22Sports fallout from covid-19
Puntmann VO, et al.,
JAMA Cardiology. 2020;5(11): 1265-1273
Rajpal
S, et al.,
JAMA Cardiology. 2020
Slide23Sports fallout from covid-19
Slide24Sports fallout from covid-19
Slide25Data from large center
Over 60 patients (average age of 14 years)
Symptoms persist in ~ 60% (dyspnea, fatigue)
Minor ECG abnormalities in 55%
Average LVEF of 63% (small percentage with systolic dysfunction)
CMR with occasional edema and LGE
Slide26Slide27Slide28Thank you