2 Prevalence and diagnostic significance of novel 12-lead ecg patterns following COVID-19 infection in elite soccer players

ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy Pub Date : 2022-06-01 DOI:10.1136/heartjnl-2022-bcs.2

R. Bhatia, A. Malhotra, H. MacLachlan, S. Gati, S. Marwaha, S. Al-Turaihi, P. Catterson, Sean Carmody, N. Chatrath, R. Cooper, H. Dhutia, S. Fyyaz, Ravi Gill, Chris Jones, Dimitrios Kalogiannidis, A. Kenny, Tamin Khanbhai, A. Ladak, C. Miles, Chris Mogekwu, Gary O’Driscoll, Paulo Angelo Bulleros, Z. Fanton, R. Osborne, D. Oxborough, John Quartermain, Kashif Quazi, D. Rakhit, M. Sala, A. Varnava, M. Esteban, G. Finocchiaro, A. Kasiakogias, S. Khoury, Shoaib Amaan, S. Basu, Rishi Dand, J. O’Shea, M. Papadakis, Sanjay Sharma

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Abstract

2 Table 1Clinical Characteristics and CMR and 31P-MRS findings HV n=15 Isolated AS n=63 Diabetes and AS n=25 P value Age, y 71±4 71±12 72±7 0.73 Female, n (%) 6(40) 7(28) 25(40) 0.3 BMI, kg/m2 26±2* 27±4€ 31±4 <0.0001 Systolic BP, mmHg 136±9 132±17 131±20 0.44 HbA1c, mmol/mol 37±3* 37±4€ 56±14 <0.0001 NT- proBNP, ng/L 67[21-112] * 1411[629-2194]† 1376[390-2362] <0.0001 Euro Score II - 1.13 1.14 0.27 Rockwood Score - 2.15 2.22 0.23 CARDIAC STRUCTURAL AND FUNCTIONAL CHANGES LV end-diastolic volume indexed to BSA, mL/m2 78±15 80±22 84±21 0.53 LV end-systolic volume indexed to BSA, ml/m2 28±6 32±22 35±19 0.24 LV mass, g 102±25* 147±41† 164±59 0.0003 LV mass to LV end-diastolic volume, g/mL 0.66±0.11* 0.99±0.26† 0.96±0.25 <0.0001 LV stroke volume, ml 95±22 94±22 100±20 0.42 LV ejection fraction,% 64±3 64±12 60±12 0.25 LV maximal wall thickness, mm 10±1* 14±3† 14±3 <0.0001 RV end-diastolic volume indexed to BSA, mL/m2 83±12 79±18 78±20 0.36 RV end-systolic volume indexed to BSA, ml/m2 32±7 37±14 37±16 0.6 RV stroke volume, ml 97±17† 82±20 84±22 0.03 RV ejection fraction,% 62±5* 55±9† 54±10 0.01 LA biplane end-systolic volumes, mL 72±20 95±50 100±44 0.16 Biplane LA EF,% 59±11* 45±17 39±19 0.008 Global longitudinal strain, (-),% 16±4* 13±4† 11±4 0.001 Peak systolic circumferential strain, (-),% 21±2 1 ±5 18±5 0.11 Peak longitudinal diastolic strain rate, s-1 0.79±0.2 0.83±0.3 0.65±0.2€ 0.04 Mean native T1, (ms) 1209±79 1232±88 1262±84 0.16 Extra cellular volume, (%) 24±3 24±2 25±4 0.54 LGE, (%) - 3.1±2 3.4±4 0.85 MYOCARDIAL ENERGETICS AND PERFUSION PCr/ATP ratio 2.17±0.5* 1.74±0.4† 1.39±0.25€ <0.0001 Increase in RPP,% 25 23 25 0.5 Stress MBF, ml/min/g 2.14±0.66* 1.68±0.6† 1.24±0.3€ <0.0001 Rest MBF, ml/min/g 0.66±0.11 0.73±0.2 0.68±0.22 0.4 MPR 3.83±1.8* 2.4±0.78† 1.78±0.47€ <0.0001 € signifies p<0.05 between AS DM and AS Control, * signifies p<0.05 between AS DM and HV, † signifies p≤0.05 between AS Control and HV.Values are mean ±standard deviations or percentages. BSA indicates body surface area;LV, Left ventricle;RV, right ventricle;DM, type 2 diabetes mellitus;HCM, hypertrophic cardiomyopathy;LV, left ventricular;LA, left atrial;LA EF, left atrial ejection fraction;PCr, phosphocreatine;ATP, adenosine tri-phosphate;RPP, rate pressure product;MBF, myocardial blood flow;MPR, myocardial perfusion reserve. 2 Figure 1Cumulative incidence of the clinical events after valve replacement (AVR) is shown in the top row. Differences in myocardial PCr/ATP ratio, global stress myocardial blood flow and global longitudinal strain between healthy volunteers, patients with isolated severe AS and patients with severe AS and DM before the AVR in PCr/ATP ratio;global stress myocardial blood flow (ml/min/g) and global longitudinal strain are shown in the middle row. Changes in energetics, stress MBF and GLS after AVR are shown in the bottom row.[Figure omitted. See PDF]Conclusion3% of elite soccer players demonstrated novel ECG changes post COVID-19 infection, of which almost 90% were diagnosed with cardiac inflammation during subsequent investigation. Most athletes with novel ECG changes exhibited cardiac symptoms. Novel ECGs changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.Conflict of InterestNone

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2优秀足球运动员新型12导联心电图的流行及诊断意义

2表1临床特征及CMR和31P-MRS结果HV n=15孤立性AS n=63糖尿病和AS n=25 P值年龄，y 71±4 71±12 72±7 0.73女性，n (%) 6(40) 7(28) 25(40) 0.3 BMI, kg/m2 26±2* 27±4€31±4 <0.0001收缩压，mmHg 136±9 132±17 131±20 0.44 HbA1c, mmol/mol 37±3* 37±4€56±14 <0.0001 NT- proBNP，ng/L 67[21-112] * 1411[629-2194]†1376[390-2362]<0.0001 Euro Score II - 1.13 1.14 0.27 Rockwood评分- 2.15 2.22 0.23心脏结构和功能改变左室舒张末期容积以BSA为指标，mL/m2 78±15 80±22 84±21 0.53左室收缩期末期容积以BSA为指标，mL/m2 28±6 32±22 35±19 0.24左室质量，g 102±25* 147±41±164±59 0.0003左室舒张末期容积，g/mL 0.66±0.11* 0.99±0.26†0.96±0.25 <0.0001左室卒中容积ml 95±22 94±22 100±20 0.42左室射血分数，% 64±3 64±12 60±12 0.25左室最大壁厚，mm 10±1* 14±3±14±3 <0.0001左室舒张末期BSA指标容积，ml/m2 83±12 79±18 78±20 0.36右室收缩期末期BSA指标容积，ml/m2 32±7 37±14 37±16 0.6右室卒中容积，ml 97±17†82±20 84±22 0.03右室射血分数，% 62±5* 55±9†54±10 0.01 LA双平面收缩期末期容积，ml 72±20 95±50 100±44 0.16双平面LA EF，% 59±11* 45±17 39±19 0.008全局纵向应力，(-)，% 16±4* 13±4†11±4 0.001收缩周应变峰值，(-)，% 21±21±5 18±5 0.11纵向舒张应变峰值，s-1 0.79±0.2 0.83±0.3 0.65±0.2€0.04平均原生T1， (ms) 1209±79 1232±88 1262±84 0.16细胞外体积，(%)24±3 24±2 25±4 0.54 LGE，(%) - 3.1±2 3.4±4 0.85心肌能量和灌注PCr/ATP比值2.17±0.5* 1.74±0.4†1.39±0.25€<0.0001 RPP增加，% 25 23 250.5应激MBF, ml/min/g 2.14±0.66* 1.68±0.6†1.24±0.3€<0.0001休息MBF，ml/min/g 0.66±0.11 0.73±0.2 0.68±0.22 0.4 MPR 3.83±1.8* 2.4±0.78†1.78±0.47€<0.0001€表示AS DM与对照组p<0.05， *表示AS DM与HV之间p<0.05，†表示AS Control与HV之间p≤0.05。数值为平均值±标准差或百分比。BSA表示体表面积，LV表示左心室，RV表示右心室，DM表示2型糖尿病，HCM表示肥厚性心肌病，LV表示左心室，LA表示左心房，LA EF表示左心房射血分数，PCr表示磷酸肌酸，ATP表示三磷酸腺苷，RPP表示心率压积，MBF表示心肌血流量，MPR表示心肌灌注储备。图1瓣膜置换术(AVR)后临床事件的累积发生率显示在最上面一行。健康志愿者、分离性严重AS患者、AVR前严重AS合并DM患者心肌PCr/ATP比、总应激心肌血流量、总纵应变的差异;中列为总应激心肌血流量(ml/min/g)和总纵应变。AVR后能量学、应力MBF和GLS的变化见下一行。(图省略。结论:3%的优秀足球运动员在新冠肺炎感染后出现了新的心电图变化，其中近90%的人在随后的调查中被诊断为心脏炎症。大多数有新的心电图改变的运动员表现为心脏症状。新的心电图变化有助于20%无心脏症状的运动员诊断为心脏炎症。利益冲突无

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ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy

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