As of March 2020, COVID-19 has become a global pandemic, halting athletic competition worldwide. Reports from China show a high prevalence of cardiac involvement in patients with severe SARS-CoV-2 infection. These cardiac forms were found to be closely associated with adverse outcomes. The use of Magnetic resonance Imaging (MRI) had allowed to show that cardiac dysfunction could be mediated by myocardial inflammation (i.e. myocarditis). The direct implication of the virus was demonstrated with Severe Acute Respiratory Syndrome (SARS)-CoV-2 being detected on myocardial biopsies in a patient with severe heart failure. The experience with other viruses causing acute myocarditis shows that there is a high rate of undetected injuries. Indeed, although severe heart failure can be present at the acute stage, acute viral myocarditis is most commonly pauci or asymptomatic, but still leaving occult myocardial scars visible on MRI, and exposing to higher risks of ventricular arrhythmia and sudden cardiac death over the long term. Although athletes are younger and have fewer comorbidities than the general population and therefore are at lower risk for severe disease or death, there is a critical and urgent need to assess the prevalence of occult scars in the population of high-level athletes returning to training after the SARS-CoV-2 pandemia.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
984
An ECG at rest is performed for all participants at Day 0. A centralized reading is performed by one of the 6 expert cardiologists participating in the research.
In case of positive COVID-19 serology and/or positive COVID-19 RT-PCR and/or new ECG abnormality and/or positive questionnaire, a stress test is performed.
In case of positive COVID-19 serology and/or positive COVID-19 RT-PCR and/or new ECG abnormality and/or positive questionnaire, a Cardiac echocardiography is performed.
In case of positive COVID-19 serology and/or positive COVID-19 RT-PCR and/or new ECG abnormality and/or positive questionnaire, a Cardiac rhythm monitoring is performed.
To determine the rhythmic risk of athletes
High resolution MRIs is performed on 200 athletes : * 100 athletes without rhythmic abnormalities (50 individuals with positive COVID-19 status and 50 individuals with negative COVID-19 status) * 100 athletes with rhythmic abnormalities (50 individuals with positive COVID-19 status and 50 individuals with negative COVID-19 status)
For all athletes included at the D0 inclusion visit, a centralized COVID-19 serology is performed to search for biomarkers associated with the occurrence of myocardial fibrosis: analysis of genetic determinants in relation to cardiac damage. For athletes who have performed MRI: Search for biomarkers associated with the occurrence of myocardial fibrosis: analyses of low-grade inflammation markers (cytokine assay and fibrosis markers).
Training center Soyaux Angoulême XV Rugby
Angoulême, France
Training Center Stade Aurillacois
Aurillac, France
Aviron Bayonnais Rugby Pro Training Center
Bayonne, France
Union Bordeaux-Bègles training center
Bègles, France
Biarritz Olympique Pays Basque training center
Biarritz, France
Bordeaux University Hospital - CRB medical office - Hôpital du Tondu
Bordeaux, France
Bordeaux University Hospital - Service UDH - Hôpital Pellegrin
Bordeaux, France
CABCL Rugby Training Center
Brive-la-Gaillarde, France
US Carcassonne Rugby training center
Carcassonne, France
Union Sportive Colomiers Rugby training center
Colomiers, France
...and 11 more locations
Presence of rhythmic risk markers bye the questionnaire
Questionnaire looking for heart palpitations, chest pain/pressure and shortness of breath.
Time frame: Day 0
Evaluation by resting ECG of rhythmic risk marker : repolarization disorders
Presence or absence of repolarization disorders
Time frame: Day 0
Evaluation by resting ECG of rhythmic risk marker : inverted T waves
Presence or absence of inverted T waves
Time frame: Day 0
Evaluation by resting ECG of rhythmic risk marker : ST segment abnormalities
Presence or absence of ST segment abnormalities
Time frame: Day 0
Evaluation by resting ECG of rhythmic risk marker : QRS fragmentation
Presence or absence of QRS fragmentation
Time frame: Day 0
Evaluation by resting ECG of rhythmic risk marker : ventricular extrasystoles (VES)
Presence or absence of VES. Ventricular extrasystoles especially with short coupling (\<300ms), falling on the T wave, width \> 160ms, complex forms (repetitive, several morphologies, instantaneous cycle \>200bpm)
Time frame: Day 0
Evaluation by resting ECG of rhythmic risk marker : ventricular tachycardia (VT)
Presence or absence of VT.
Time frame: Day 0
Presence of rhythmic risk markers bye the stress test
VES, especially with short coupling (\<300ms), falling on the T wave, width \> 160ms, complex shapes (repetitive, several morphologies, instantaneous cycle \>200bpm), ventricular tachycardias (VT). The analysis focus on the exercise period, and the recovery period. Ventricular arrhythmias will be quantified.
Time frame: Day 0
Presence of rhythmic risk markers bye ECG holter
VES, especially with short coupling (\<300ms), falling on the T wave, width \> 160ms, complex shapes (repetitive, multiple morphologies, instantaneous cycle \>200bpm), ventricular tachycardias (VTs). Ventricular arrhythmias are quantified.
Time frame: Day 0
Presence of rhythmic risk markers bye ECG monitoring during games and trainings
In case of moderate arrhythmia on stress test and/or Holter ECG, ECG monitoring during training sessions and matches is carried out with analysis of the tracings collected, in search of more sustained arrhythmia, particularly at the ventricular level.
Time frame: Day 0
Presence of rhythmic risk markers by pharmacological tests and/or electrophysiological exploration
If the risk is perceived as very high, pharmacological tests (Isuprel®) and/or electrophysiological exploration may be performed during hospitalization, in search of dangerous rhythm disorders, particularly at the ventricular level.
Time frame: Day 0
Presence of myocardial fibrosis by injected MRI
In order to compare the prevalence of myocardial fibrosis between COVID-19 positive and COVID-19 negative individuals in high level athletes with or without rhythmic risk, a high resolution MRI is performed. The examinations is performed on 1.5 or 3T MRI systems equipped with specific antennas for cardiology. The sequence used to detect occult scars is a late enhancement sequence performed at least 15 minutes after injection of gadolinium salts, using a free-breathing 3D method, for a minimum spatial resolution of 2.5x1.25x1.25mm. The images are reviewed by a core lab at the Bordeaux University Hospital. The presence or absence of myocardial fibrosis is evaluated.
Time frame: Month 3
Presence of transmural localization of myocardial fibrosis by injected MRI
In order to compare the prevalence of myocardial fibrosis between COVID-19 positive and COVID-19 negative individuals in high level athletes with or without rhythmic risk, a high resolution MRI is performed. The examinations is performed on 1.5 or 3T MRI systems equipped with specific antennas for cardiology. The sequence used to detect occult scars is a late enhancement sequence performed at least 15 minutes after injection of gadolinium salts, using a free-breathing 3D method, for a minimum spatial resolution of 2.5x1.25x1.25mm. The images are reviewed by a core lab at the Bordeaux University Hospital. The presence or absence of transmural localization is evaluated.
Time frame: Month 3
Measurement of cardiac scar size by injected MRI
In order to compare the prevalence of myocardial fibrosis between COVID-19 positive and COVID-19 negative individuals in high level athletes with or without rhythmic risk, a high resolution MRI is performed. The examinations is performed on 1.5 or 3T MRI systems equipped with specific antennas for cardiology. The sequence used to detect occult scars is a late enhancement sequence performed at least 15 minutes after injection of gadolinium salts, using a free-breathing 3D method, for a minimum spatial resolution of 2.5x1.25x1.25mm. The images are reviewed by a core lab at the Bordeaux University Hospital. The size of scars is measured in milliliters (mL).
Time frame: Month 3
Search for constitutional genetic biomarkers
identification by sequencing of genetic variants that could have an impact on the occurrence of a severe form in individuals infected with SARS-CoV-2.
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Time frame: Month 5
Research of inflammation markers
Th1/Th2/activation/inflammation/apoptosis markers are measured in sera by a Luminex test allowing the detection of 10 analytes with a commercial kit according to the manufacturer's instructions
Time frame: Month 5