Athlete hearts and COVID

Big “news” this week on COVID and the heart. You may have heard something about a new study published about the link between recovery from COVID and inflammation in the hearts of competitive athletes.

It’s another great example of how the SARS-CoV-2 virus impacts us - the virus can get into any organ of an infected patient that expresses an ACE2 receptor, but only impacts the brain of those who aren’t infected.

This study was heralded as big news, but it’s almost entirely nonsense.

Not only can we not draw any conclusions from this research, I would argue this provides exactly zero information.

I’m not confused about why this made news. That seems obvious:

1. This is scary stuff! Apparently even elite athletes develop significant cardiovascular damage from COVID

2. The director of athletic medicine at Penn State, Dr. Wayne Sebastianelli, completely misrepresented the research findings, inflating the fear factor and getting the numbers wrong

I’m confused by two major things here:

1. How did this study get published?

2. Why it was accepted by such a prestigious journal?

This study is nonsense

The researchers in this study took 26 college athletes from various sports who had confirmed COVID-19 infection and did cardiac MRIs on them.

They found evidence of active inflammation in the heart muscle in 4 athletes (15%) and evidence of some degree of scar in 8 other patients (30%).

So with these objective findings, why do I describe this as nonsense?

Because this study wasn’t designed to be anything other than clickbait. There were no control patients in this trial - meaning, there were no non-COVID athletes to compare the COVID hearts to. Maybe this is a pattern that’s identical to what we’d see if we did cardiac MRIs of normal athletes.

Without matching the patients to controls, you have no idea if these findings are because of COVID or just incidental. Maybe the COVID patients actually have less inflammation than athletes who haven’t been infected. I’m not suggesting this is likely, but the point is that you never know.

Abnormal findings are common in the when you do studies on normal people

There’s a medical term for this: incidentaloma.

This is a cute term to describe findings something you weren’t looking for - incidental, meaning incidental; oma, meaning mass.

We deal with this all the time in the medical world. You do a test for one reason or another, and you find something that you weren’t expecting.

When you do studies on normal people, you find an incidentaloma more than 2/3 of the time.

So we know that sending normal people for scans has a high likelihood of findings things that are abnormal. We also already know that cardiac MRIs done on athletes - even healthy ones - can have abnormal scar findings.

Take a look at this graph from a paper published in 2009 in athletes getting MRIs when they had the common cold:

Look at the baseline visit numbers - you see similar findings of swelling and inflammation in the baseline visit section: athletes sent for cardiac MRI before getting a cold have similar MRI findings to athletes post COVID infection.

The value of this research is exactly what you paid for this newsletter

The amount of news to be presented doesn’t rise and fall with how much important information there is to convey, so it’s common to have nonsense scientific stuff in the news all the time.

This is the cardiac equivalent of the latest nutritional research linking dark chocolate to a longer life or coffee to an early grave that gets a segment on the Today Show.

It’s so dangerous to have people who didn’t read the medical research themselves - or those who don’t know how to interpret the research findings - pontificating with authority on what it means for the rest of us.

To think that they might be making decisions about whether to continue with the college football season based on research like this is laughable.

Research can only answer a question that’s being asked - and this study didn’t ask a question that can give us information about whether it’s safe to play football after having COVID.

Maybe we should skip the cardiac MRIs and give all the athletes hydroxychloroquine. Then we can continue the season without interruption.

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