Background:
The long-term cardiovascular consequences of SARS-CoV-2 infection in athletes remain uncertain. This prospective study aimed to evaluate longitudinal changes in cardiac structure, function, and cardiopulmonary performance over 12 months following mild SARS-CoV-2 infection in athletes.
Methods:
Fifty-two elite and recreational athletes (age 36 ± 13.5 years, 27 females, VO₂peak 36.7 ± 10.4 ml/kg/min) from endurance (n=35), power (n=8), and mixed sports (n=8) underwent comprehensive assessment shortly after infection (T1) and at 12-month follow-up (T2). Examinations included echocardiography with quantification of left and right ventricular global longitudinal strain (LV/RV GLS), RV free wall strain (FWSL), and left atrial strain values, as well as cardiopulmonary exercise testing (CPET) and bioimpedance-based anthropometry. Statistical comparisons between T1 and T2 were performed using paired t-tests or Wilcoxon tests, with calculation of effect sizes.
Results:
No significant longitudinal changes were found in echocardiographic or CPET parameters, except for a lower E/E′ medial at follow-up (T1: 8.01 ± 1.98 vs. T2: 7.28 ± 1.54, p = 0.008), a higher respiratory exchange ratio at the first ventilatory threshold (T1: 0.90 ± 0.07 vs. T2: 0.93 ± 0.05, p = 0.013), and a higher resting heart rate shortly after infection (T1: 68 ± 12 vs. T2: 64 ± 10 bpm, p = 0.010). Small but significant increases were observed in BMI (T1: 23.7 ± 3.2 vs. T2: 24.1 ± 3.2, p = 0.018) and body surface area (T1: 1.88 ± 0.20 vs. T2: 1.89 ± 0.20, p = 0.035), with trends toward higher body fat (p = 0.053) and higher relative FEV₁ (p = 0.055) at follow-up. Creatine kinase levels were significantly higher after 12 months (T1: 129 ± 104 vs. T2: 189 ± 172 U/L, p < 0.001).
Conclusion:
In athletes recovering from mild SARS-CoV-2 infection, no relevant long-term impairment of cardiac function or cardiopulmonary performance was observed after 12 months. Subtle changes in diastolic indices, body composition, and biomarkers may reflect physiological adaptation rather than persistent pathology. These findings support a generally favorable long-term cardiovascular outcome in athletes following mild COVID-19.
