Assessment of cardiac function before and after SARS-CoV-2 infection in elite athletes using left and right ventricular global longitudinal strain and global circular strain

Jana Schellenberg (Ulm)1, L. Matits (Ulm)1, D. A. Bizjak (Ulm)1, J. Kirsten (Ulm)1, J. Kersten (Ulm)2

1Universitätsklinikum Ulm Sektion für Sport- und Rehabilitaionsmedizin Ulm, Deutschland; 2Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland



We previously observed a possible mild myocardial involvement in the form of reduced left ventricular global longitudinal strain (LV GLS) in athletes after SARS-CoV-2 infection compared with healthy athletes. It is still unclear whether these minor changes are due to viral damage to the myocardium or a break in training. The primary objective of this study was to assess potential alteration in LV and right ventricular (RV) GLS and global circular strain (GCS) in elite athletes (INFAt) before and after SARS-CoV-2 infection and, second, to determine differences in cardiac function between INFAt after infection and healthy control athletes (CON).


LV GLS and GCS were determined in four-, two-, and three-chamber views and RV free wall longitudinal strain/four chambers longitudinal strain (RV FWSL/RV 4CLS) in RV focused four-chamber apical view. Strain values were assessed offline by a blinded investigator in 16 INFAt (22.63 ± 5.34 years, 10 male) and in 16 sex- and age-matched CON. INFAt were examined in our outpatient clinic before (t0) and at a median of 52 days after (t1) SARS-CoV-2 infection. Athletes participated in endurance, strength and mixed sports.


There was no change in LV GLS (t- 21.8 vs. t-21.7, p=0.649), GCS basal (t-32.9 vs. t-26.6, p=0.403), GCS midventricular (t-23.7 vs. t-29.9, p=0.589) and RV FWSL (t-31.9 vs. t-33.0, p=0.326) or RV 4CLS (t-29.1 vs. t-28.7, p=0.626) in INFAt from from pre to post-SARS-CoV-2 infection. Overall LV GLS (-21.7 vs. -22.7, p=0.318), GCS basal (-26.6 vs. -25.8, p=0.409) and GCS mid-ventricular (-29.9 vs. -29.0, p=0.788) and routine echocardiography parameters were not different between INFAt and CON.


We did not detect cardiac involvement in the form of a significant reduction of LV GLS and GCS within INFAt before and after SARS-CoV-2 infection nor between INFAt and CON. Cardiac function does not appear to be impaired in athletes with mild infection. Investigations on alterations of GLS and GCS in athletes or in the general population with moderate and severe disease courses would be necessary, as would studies in other viral infections, to issue a specific return-to-play recommendation following viral infection diseases.

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