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Scanning the heart after COVID without symptoms: Not a good idea

Cardiac MRI (CMR) may be able to detect abnormalities suggestive of myocarditis after recovery of COVID-19 – or rule them out – but should not be used in this way in the absence of symptoms, a group of cardiologists, radiologists, and others have argued .

“We want to emphasize that the prevalence, clinical significance and long-term effects of CMR surrogates on myocardial damage on morbidity and mortality are unknown,” they wrote in an open letter signed by about 50 medical professionals from a number of disciplines.

While there is no better evidence, “testing of asymptomatic members of the general public after COVID-1

9 is not indicated outside carefully planned and approved research studies with appropriate control groups,” the group argued.

The letter called on the 18 professional societies to which it was sent, including the American College of Cardiology (ACC), the American Heart Association and the American College of Radiology, to provide clear guidelines for stopping people seeking CMR screening for this purpose.

The controversy erupted with a German study that found a late increase in gadolinium and other CMR abnormalities suggesting injury and inflammation of the myocardium in a group of people who recovered from largely mild or moderate cases of COVID-19 compared to healthy controls. and compared risk factors controls.

Then researchers at Ohio State University last week published CMR scans of fellow athletes after asymptomatic or mild SARS-CoV-2 infection: 15% had findings suggestive of myocarditis and 31% had LGE without an increase in T2 suggesting previous myocardial injury.

No study can prove that COVID-19 caused the abnormalities or say what the long-term consequences will be. But both were used to make decisions about sports safety.

The German group was cautious in its interpretation. However, Ohio researchers write that CMR could potentially separate a high-risk group from those athletes who are safe to participate, “because CMR mapping techniques have a high negative prognostic value to rule out myocarditis.” A Bloomberg the story from Ohio State declared it a “call to screen athletes from college.”

Ohio football fan site, Eleven warriors, which is lobbying for the game to continue on schedule, accepted the latest survey as good news. Lead author Saurab Rajpal, PhD, told the site, “So if you do an MRI and the heart doesn’t show myocarditis, at OSU we give athletes [recovering from COVID-19] get back to practice. We allow them to return to the usual intensity of the exercises if their MRI is negative. “

This is a bad idea for the general public, the letter said, noting that people are looking for CMR for asymptomatic screening.

“My personal opinion is that casual athletics will be included, but elite athletes may not,” said the first author of the letter, Venkatesh Murty, a PhD from the University of Michigan in Ann Arbor. MedPage today.

Guidelines for consensus from the ACC Council of Cardiology for Sport and Exercise on return to play calls for normalization of ventricular function, lack of biomarker evidence of inflammation and absence of inducible arrhythmias with risk stratification after 3 to 6 months of exercise limitations and ” based on extensive tests including echocardiography, stress testing and rhythm monitoring. “

For athletes, even with asymptomatic infection, it is recommended to “consider a heart test if there are concerns about heart involvement,” the guidelines said.

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