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14. Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection

Author

Daniels, Curt J., Rajpal, Saurabh, Greenshields, Joel T., Rosenthal, Geoffrey L., Chung, Eugene H., Terrin, Michael, Jeudy, Jean, Mattson, Scott E., Law, Ian H., Borchers, James, Kovacs, Richard, Kovan, Jeffrey, Rifat, Sami F., Albrecht, Jennifer, Bento, Ana I., Albers, Lonnie, Bernhardt, David, Day, Carly, Hecht, Suzanne, Hipskind, Andrew, Mjaanes, Jeffrey, Olson, David, Rooks, Yvette L., Somers, Emily C., Tong, Matthew S., Wisinski, Jeffrey, Womack, Jason, Esopenko, Carrie, Kratochvil, Christopher J., and Rink, Lawrence D.

Subjects
Adult, Male, SARS-CoV-2, Research, COVID-19, Magnetic Resonance Imaging, Cine, United States, Myocarditis, Athletes, Prevalence, Online First, Humans, Mass Screening, Female, Registries, Pandemics, Comments, Original Investigation
Abstract

This cohort study assesses the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play., Key Points Question What is the prevalence of myocarditis in competitive athletes after COVID-19 infection, and how would different approaches to screening affect detection? Findings In this cohort study of 1597 US competitive collegiate athletes undergoing comprehensive cardiovascular testing, the prevalence of clinical myocarditis based on a symptom-based screening strategy was only 0.31%. Screening with cardiovascular magnetic resonance imaging increased the prevalence of clinical and subclinical myocarditis by a factor of 7.4 to 2.3%. Meaning These cardiac magnetic resonance imaging findings provide important data on the prevalence of clinical and subclinical myocarditis in college athletes recovering from symptomatic and asymptomatic COVID-19 infections., Importance Myocarditis is a leading cause of sudden death in competitive athletes. Myocardial inflammation is known to occur with SARS-CoV-2. Different screening approaches for detection of myocarditis have been reported. The Big Ten Conference requires comprehensive cardiac testing including cardiac magnetic resonance (CMR) imaging for all athletes with COVID-19, allowing comparison of screening approaches. Objective To determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play. Design, Setting, and Participants Big Ten COVID-19 Cardiac Registry principal investigators were surveyed for aggregate observational data from March 1, 2020, through December 15, 2020, on athletes with COVID-19. For athletes with myocarditis, presence of cardiac symptoms and details of cardiac testing were recorded. Myocarditis was categorized as clinical or subclinical based on the presence of cardiac symptoms and CMR findings. Subclinical myocarditis classified as probable or possible myocarditis based on other testing abnormalities. Myocarditis prevalence across universities was determined. The utility of different screening strategies was evaluated. Exposures SARS-CoV-2 by polymerase chain reaction testing. Main Outcome and Measure Myocarditis via cardiovascular diagnostic testing. Results Representing 13 universities, cardiovascular testing was performed in 1597 athletes (964 men [60.4%]). Thirty-seven (including 27 men) were diagnosed with COVID-19 myocarditis (overall 2.3%; range per program, 0%-7.6%); 9 had clinical myocarditis and 28 had subclinical myocarditis. If cardiac testing was based on cardiac symptoms alone, only 5 athletes would have been detected (detected prevalence, 0.31%). Cardiac magnetic resonance imaging for all athletes yielded a 7.4-fold increase in detection of myocarditis (clinical and subclinical). Follow-up CMR imaging performed in 27 (73.0%) demonstrated resolution of T2 elevation in all (100%) and late gadolinium enhancement in 11 (40.7%). Conclusions and Relevance In this cohort study of 1597 US competitive athletes with CMR screening after COVID-19 infection, 37 athletes (2.3%) were diagnosed with clinical and subclinical myocarditis. Variability was observed in prevalence across universities, and testing protocols were closely tied to the detection of myocarditis. Variable ascertainment and unknown implications of CMR findings underscore the need for standardized timing and interpretation of cardiac testing. These unique CMR imaging data provide a more complete understanding of the prevalence of clinical and subclinical myocarditis in college athletes after COVID-19 infection. The role of CMR in routine screening for athletes safe return to play should be explored further.

Published
2021

16. ACCF/ACR/AHA/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR 2008 Health Policy Statement on Structured Reporting in Cardiovascular Imaging

Author

Douglas, Pamela S., Hendel, Robert C., Cummings, Jennifer E., Dent, John M., Hodgson, John McB., Hoffmann, Udo, Horn, Robert J., III, Hundley, W. Gregory, Kahn, Charles E., Jr, Martin, Gerard R., Masoudi, Frederick A., Peterson, Eric D., Rosenthal, Geoffrey L., Solomon, Harry, Stillman, Arthur E., Teague, Shawn D., Thomas, James D., Tilkemeier, Peter L., and Guy Weigold, Wm.

Published
2009
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22. Rat model of pulmonary arteriovenous malformations after right superior cavopulmonary anastomosis

Author

Starnes, Sandra L., Duncan, Brian W., Fraga, Charles H., Desai, Shailesh Y., Jones, Thomas K., Mathur, Sanjeev K., Rosenthal, Geoffrey L., and Lupinetti, Flavian M.

Subjects
Anastomosis, Heart, Surgical anastomosis, Biological sciences
Abstract

We developed a rat model of pulmonary arteriovenous malformations after cavopulmonary anastomosis. We sought to determine whether this model reproduces the angiographic and histologic features seen in the human condition. Eight Sprague-Dawley rats underwent a right superior cavopulmonary anastomosis with the use of microsurgical techniques. Between 2 and 13 mo, pulmonary angiography was performed, the animals were euthanized, and the lungs were removed. Microscopic sections of the lung were stained with an endothelial-specific antibody (yon Willebrand factor). Microvessel density was determined by counting vessels staining positively for yon Willebrand factor, and the shunted and nonshunted (control) lungs were compared for each animal. Pulmonary angiography revealed time-dependent development of arteriovenous malformations. Microvessel density demonstrated a time-dependent increase in the shunted lung compared with the control lung (simple linear regression of the ratio of the microvessel density of the shunted lung divided by the microvessel density of the control lung on time; [R.sup.2] = 0.79, P = 0.003). This animal model reproduces the same angiographic and microscopic features of pulmonary arteriovenous malformations that develop in humans after cavopulmonary anastomosis. This appears to be a valid model that may be used to further study etiologic mechanisms for this phenomenon. congenital heart surgery; cavopulmonary anastomosis

Published
2002

23. Pericardial effusion and tamponade in infants with central catheters

Author

Nowlen, Todd T., Rosenthal, Geoffrey L., Johnson, Gregory Lee, Tom, Deborah J., and Vargo, Thomas A.

Subjects
Pericardial effusion -- Causes of, Intravenous catheterization -- Complications, Infants (Newborn) -- Health aspects
Abstract

Objective. To describe the clinical presentation, cause, and outcome of central venous catheter (CVC)-related pericardial effusions (PCE) in infants. Methods. A retrospective case review was conducted of CVC-related PCE at university and private neonatal intensive care units. Data from our cases were combined with published case reports and included clinical presentation and outcome; biochemical evaluation of pericardial fluid; days until diagnosis; cardiothoracic ratios; and CVC characteristics, insertion site, and tip placement site. Results. In our cases, 6 different neonatology groups cared for 14 patients at 6 different hospitals in 2 cities. These data were combined with 47 cases reviewed from the literature. Pericardial fluid was obtained in 54 cases from the combined group and was described qualitatively as consistent with the infusate in 53 of 54 cases (98%). Biochemical analysis was performed in 37 cases, and in 36 of 37 cases (97%), the pericardial fluid was consistent with the infusate. The median gestational age at birth was 30.0 weeks (range: 23.5-42). The median time from CVC insertion to diagnosis was 3.0 days (range: 0.2-37; n = 59). Sudden cardiac collapse was reported in 37 cases (61%), and unexplained cardiorespiratory instability was reported in 22 cases (36%). The CVC tip was last reported within the pericardial reflections on chest radiograph in 56 cases (92%) at the time of PCE diagnosis. The mean cardiothoracic ratio increased 17% (n = 14). No patients died among our cases. Among the reviewed cases, 45% mortality was reported. For the combined group, mortality was 34%. For the combined group, mortality was 8% (3 of 37) in the patients who underwent pericardiocentesis versus 75% (18 of 24) for the patients who did not. In 21 patients, the catheter was withdrawn and remained in use. Survivors and nonsurvivors had comparable gestational age at birth, birth weight, days to PCE diagnosis, and day of life of PCE symptoms/diagnosis. Access site, catheter type, and catheter size were not associated with mortality. An association between larger catheters and shorter time to PCE may be present. Access site and catheter type were not associated with time to PCE. Autopsy specimens reported 6 cases of myocardial necrosis/thrombus formation, 9 cases of perforation without myocardial necrosis/thrombus formation, and 2 cases in which both were reported. Conclusions. The pericardial fluid found in CVC-associated PCE is consistent with the infusate. We speculate that there are several mechanisms, ranging from frank perforation that seals spontaneously to CVC tip adhesion to the myocardium with diffusion into the pericardial space. Routine radiography should be performed, and the CVC tip should be readily identifiable. The CVC tip should remain outside the cardiac silhouette but still within the vena cavae (approximately 1 cm outside the cardiac silhouette in premature infants and 2 cm in term infants). A change in cardiothoracic ratio may be diagnostic of a PCE, and pericardiocentesis is associated with significantly reduced mortality. Increased awareness of this complication may decrease the mortality associated with CVC-related PCE. Pediatrics 2002;110:137-142; pericardial effusion, cardiac tamponade, catheters, indwelling, infant., Pericardial effusion (PCE) and fatal tamponade are complications of central venous catheter (CVC) use in infants. Although the estimated incidence is low, (1) many case reports describe PCE and tamponade [...]

Published
2002

24. Association of viral genome with graft loss in children after cardiac transplantation

Author

Shirali, Girish S., Ni, Jiyuan, Chinnock, Richard E., Johnston, Joyce K., Rosenthal, Geoffrey L., Bowles, Neil E., and Towbin, Jeffrey A.

Subjects
Adenoviruses, Human -- Health aspects, Graft rejection -- Causes of, Heart -- Transplantation
Abstract

Adenovirus infection of a transplanted heart may lead to organ rejection or coronary artery disease in the transplanted heart, according to a study of 149 children. Researchers used PCR to test 553 heart biopsy samples from the children and found adenovirus in 30 out of 48 samples that tested positive for a virus.

Published
2001

28. Intravenous Mesenchymal Stem Cells in Extracorporeal Oxygenation Patients with Severe COVID-19 Acute Respiratory Distress Syndrome

Author

Kaushal, Sunjay, primary, Khan, Aisha, additional, Deatrick, Kristopher, additional, Ng, Derek K., additional, Snyder, Abigail, additional, Shah, Aakash, additional, Caceres, Lina V., additional, Bacallao, Ketty, additional, Bembea, Melania, additional, Everett, Allen, additional, Zhu, Jie, additional, Kaczorowski, David, additional, Madathil, Ronson, additional, Tabatabai, Ali, additional, Rosenthal, Geoffrey, additional, Brooks, Adriana, additional, Longsomboon, Bangon, additional, Mishra, Rachana, additional, Saha, Progyaparamita, additional, Desire, Yvenie, additional, Saltzman, Russell, additional, G.Hankey, Kim, additional, Arias, Sixto A., additional, Ayoade, Folusakin, additional, Tovar, Jairo A., additional, Lamazares, Rejane, additional, Gershengorn, Hayley B., additional, Fontaine, Magali J., additional, Klein, Matt, additional, Mullins, Kristin, additional, Gunasekaran, Muthukumar, additional, Loebe, Matthias, additional, Karakeshishyan, Vela, additional, Jayaweera, Dushyantha T., additional, Atala, Anthony, additional, Ghodsizad, Ali, additional, and Hare, Joshua M., additional

Published
2020
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