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Original article

Vol. 153 No. 12 (2023)

Mid- to long-term cardiac magnetic resonance findings in elite athletes recovered from COVID-19: results from an ongoing observational COVID-19 study at a German Olympic medical centre

  • Christopher Schneeweis
  • Katharina Diebold
  • Thomas Schramm
  • Christine Syrek
  • Hans-Georg Predel
  • Robert Manka
  • Jonas Zacher
Cite this as:
Swiss Med Wkly. 2023;153:3534


INTRODUCTION: The cardiac magnetic resonance (CMR) data on mid- to long-term myocardial damage due to COVID-19 infections in elite athletes are scarce. Therefore, this study investigated the mid -to long-term consequences of myocardial involvement after a COVID-19 infection in elite athletes.

MATERIALS AND METHODS: This study included 27 athletes at the German Olympic Centre North Rhine-Westphalia (NRW)/Rhineland with a confirmed previous COVID-19 infection between January 2020 and October 2021. The athletes were part of an ongoing observational COVID-19 study at the Institute of Cardiology and Sports Medicine Cologne at the German Sport University (DSHS).Nine healthy non-athletes with no prior COVID-19 illness served as controls. CMR was performed within a mean of 182 days (standard deviation [SD] 99) of the initial positive test result.

RESULTS: CMR did not reveal any signs of acute myocarditis (according to the current Lake Louise criteria) or myocardial damage in any of the 26 elite athletes with previous COVID-19 infection. Of these athletes, 92% experienced a symptomatic course, and 54% reported symptoms lasting for more than 4 weeks. One male athlete was excluded from the analysis because CMR revealed an arrhythmogenic right ventricular cardiomyopathy (ARVC). Athletes had significantly enlarged left and right ventricle volumes and increased left ventricular myocardial mass in comparison to the healthy control group (LVEDVi 103.4 vs 91.1 ml/m2, p = 0.031; RVEDVi 104.1 vs 86.6 ml/m2, p = 0.007; LVMi 59.0 vs 46.2 g/m2, p = 0.002). Only two cases of elevated high-sensitivity-Troponin were documented; in one, the participant had previously engaged in high-intensity training, and in the other, CMR revealed a diagnosis of an arrhythmogenic cardiomyopathy.

CONCLUSION: Our findings suggest that the risk for mid- to long-term myocardial damage is very low to negligible in elite athletes. Our results do not allow conclusions to be drawn regarding myocardial injury in the acute phase of infection nor about possible long-term myocardial effects in the general population.


  1. Manka R, Karolyi M, Polacin M, Holy EW, Nemeth J, Steiger P, et al. Myocardial edema in COVID-19 on cardiac MRI. J Heart Lung Transplant. 2020 Jul;39(7):730–2. 10.1016/j.healun.2020.04.025 DOI:
  2. Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Nov;5(11):1265–73. 10.1001/jamacardio.2020.3557 DOI:
  3. Kotecha T, Knight DS, Razvi Y, Kumar K, Vimalesvaran K, Thornton G, et al. Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance. Eur Heart J. 2021 May;42(19):1866–78. 10.1093/eurheartj/ehab075
  4. Phelan D, Kim JH, Elliott MD, Wasfy MM, Cremer P, Johri AM, et al. Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement. JACC Cardiovasc Imaging. 2020 Dec;13(12):2635–52. 10.1016/j.jcmg.2020.10.005 DOI:
  5. Captur G, Manisty C, Moon JC. Cardiac MRI evaluation of myocardial disease. Heart. 2016 Sep;102(18):1429–35. 10.1136/heartjnl-2015-309077 DOI:
  6. Patriki D, Gresser E, Manka R, Emmert MY, Lüscher TF, Heidecker B. Approximation of the Incidence of Myocarditis by Systematic Screening With Cardiac Magnetic Resonance Imaging. JACC Heart Fail. 2018 Jul;6(7):573–9. 10.1016/j.jchf.2018.03.002 DOI:
  7. Peterson DF, Kucera K, Thomas LC, Maleszewski J, Siebert D, Lopez-Anderson M, et al. Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study. Br J Sports Med. 2021 Nov;55(21):1196–203. 10.1136/bjsports-2020-102666 DOI:
  8. Nieß A, Bloch W, Friedmann-Bette B, Grim C, Halle M, Hirschmüller A, et al. Position stand: return to sport in the current Coronavirus pandemic (SARS-CoV-2 / COVID-19). Dtsch Z für SportmedGer J Sports Med. 2020;71(5):E1–4. DOI:
  9. Elliott N, Martin R, Heron N, Elliott J, Grimstead D, Biswas A. Infographic. Graduated return to play guidance following COVID-19 infection. Br J Sports Med. 2020 Oct;54(19):1174–5. 10.1136/bjsports-2020-102637 DOI:
  10. Clark DE, Parikh A, Dendy JM, Diamond AB, George-Durrett K, Fish FA, et al. COVID-19 Myocardial Pathology Evaluation in Athletes With Cardiac Magnetic Resonance (COMPETE CMR). Circulation. 2021 Feb;143(6):609–12. 10.1161/CIRCULATIONAHA.120.052573 DOI:
  11. Rajpal S, Tong MS, Borchers J, Zareba KM, Obarski TP, Simonetti OP, et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiol. 2021 Jan;6(1):116–8. DOI:
  12. Małek ŁA, Marczak M, Miłosz-Wieczorek B, Konopka M, Braksator W, Drygas W, et al. Cardiac involvement in consecutive elite athletes recovered from Covid-19: A magnetic resonance study. J Magn Reson Imaging. 2021 Jun;53(6):1723–9. 10.1002/jmri.27513 DOI:
  13. Vago H, Szabo L, Dohy Z, Merkely B. Cardiac Magnetic Resonance Findings in Patients Recovered From COVID-19: Initial Experiences in Elite Athletes. JACC Cardiovasc Imaging. 2021 Jun;14(6):1279–81. 10.1016/j.jcmg.2020.11.014 DOI:
  14. Sharma G, Blumenthal RS, Martinez MW. COVID-19, Myocarditis, and Cardiac MRI in Athletes: Distinguishing Signal from Noise.pdf. American College in Cardioilogy.
  15. Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: expert Recommendations. J Am Coll Cardiol. 2018 Dec;72(24):3158–76. 10.1016/j.jacc.2018.09.072 DOI:
  16. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation. 2009 Mar;119(8):1085–92. 10.1161/CIRCULATIONAHA.108.804617 DOI:
  17. Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Russ J Cardiol. 2021;26(5):4488. 10.15829/1560-4071-2021-4488 DOI:
  18. Wroblewski J, Mahajan P, Li RL, Busch J, Rhee B. Long term characterization of athletes recovering from COVID-19 infection and return to play. J Am Coll Cardiol. 2022;79(9):2061. 10.1016/S0735-1097(22)03052-2 DOI:
  19. Martinez MW, Tucker AM, Bloom OJ, Green G, DiFiori JP, Solomon G, et al. Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening. JAMA Cardiol. 2021 Jul;6(7):745–52. 10.1001/jamacardio.2021.0565 DOI:
  20. Berg J, Kottwitz J, Baltensperger N, Kissel CK, Lovrinovic M, Mehra T, et al. Cardiac Magnetic Resonance Imaging in Myocarditis Reveals Persistent Disease Activity Despite Normalization of Cardiac Enzymes and Inflammatory Parameters at 3-Month Follow-Up. Circ Heart Fail. 2017 Nov;10(11):e004262. 10.1161/CIRCHEARTFAILURE.117.004262 DOI:
  21. Gluckman TJ, Bhave NM, Allen LA, Chung EH, Spatz ES, Ammirati E, et al.; Writing Committee. 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022 May;79(17):1717–56. 10.1016/j.jacc.2022.02.003 DOI:
  22. Małek ŁA, Mazurkiewicz Ł, Marszałek M, Barczuk-Falęcka M, Simon JE, Grzybowski J, et al. Deformation Parameters of the Heart in Endurance Athletes and in Patients with Dilated Cardiomyopathy-A Cardiac Magnetic Resonance Study. Diagnostics (Basel). 2021 Feb;11(2):374. 10.3390/diagnostics11020374 DOI:
  23. D’Ascenzi F, Anselmi F, Piu P, Fiorentini C, Carbone SF, Volterrani L, et al. Cardiac Magnetic Resonance Normal Reference Values of Biventricular Size and Function in Male Athlete’s Heart. JACC Cardiovasc Imaging. 2019 Sep;12(9):1755–65. 10.1016/j.jcmg.2018.09.021 DOI:

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