Article Text

Download PDFPDF
SARS-CoV-2 infection and return to play in junior competitive athletes: is systematic cardiac screening needed?
  1. Luna Cavigli1,
  2. Michele Cillis1,
  3. Veronica Mochi1,
  4. Federica Frascaro1,
  5. Nicola Mochi2,
  6. Arnel Hajdarevic3,4,
  7. Alessandra Roselli5,6,
  8. Massimo Capitani7,
  9. Federico Alvino7,
  10. Silvia Giovani7,
  11. Corrado Lisi2,
  12. Maria Teresa Cappellini2,
  13. Rosa Anna Colloca2,
  14. Giulia Elena Mandoli1,
  15. Serafina Valente8,
  16. Marta Focardi1,
  17. Matteo Cameli1,
  18. Marco Bonifazi9,
  19. Flavio D'Ascenzi1
  1. 1 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
  2. 2 Sports Medicine Unit, USL Toscana Centro, Italy, Firenze, Italy
  3. 3 Medical Lab, Center for Sports Medicine and Rehabilitation, Asti, Italy
  4. 4 Turin E. R. G. E. Center for Sports Medicine, Turin, Italy
  5. 5 Institute of Sports Medicine, Firenze, Italy
  6. 6 Center for Sports Medicine, Sam Miniato, Italy
  7. 7 Center for Sports Medicine, National Health Service, Siena, Italy
  8. 8 Clinical and Surgical Cardiology Uniti, Cardiothoracic and Vascular Department, University Hospital Le Scotte, Siena, Italy
  9. 9 Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
  1. Correspondence to Associate Professor Flavio D'Ascenzi, Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy; flavio.dascenzi{at}


Background SARS-CoV-2 infection might be associated with cardiac complications in low-risk populations, such as in competitive athletes. However, data obtained in adults cannot be directly transferred to preadolescents and adolescents who are less susceptible to adverse clinical outcomes and are often asymptomatic.

Objectives We conducted this prospective multicentre study to describe the incidence of cardiovascular complications following SARS-CoV-2 infection in a large cohort of junior athletes and to examine the effectiveness of a screening protocol for a safe return to play.

Methods Junior competitive athletes suffering from asymptomatic or mildly symptomatic SARS-CoV-2 infection underwent cardiac screening, including physical examination, 12-lead resting ECG, echocardiogram and exercise ECG testing. Further investigations were performed in cases of abnormal findings.

Results A total of 571 competitive junior athletes (14.3±2.5 years) were evaluated. About half of the population (50.3%) was mildly symptomatic during SARS-CoV-2 infection, and the average duration of symptoms was 4±1 days. Pericardial involvement was found in 3.2% of junior athletes: small pericardial effusion (2.6%), moderate pericardial effusion (0.2%) and pericarditis (0.4%). No relevant arrhythmias or myocardial inflammation was found in subjects with pericardial involvement. Athletes with pericarditis or moderate pericardial effusion were temporarily disqualified, and a gradual return to play was achieved after complete clinical resolution.

Conclusions The prevalence of cardiac involvement was low in junior athletes after asymptomatic or mild SARS-CoV-2 infection. A screening strategy primarily driven by cardiac symptoms should detect cardiac involvement from SARS-CoV-2 infection in most junior athletes. Systematic echocardiographic screening is not recommended in junior athletes.

  • athletes
  • COVID-19
  • child health
  • sports

Data availability statement

Data are available upon reasonable request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Twitter @MicheleCillis10

  • Contributors LC and FD'A wrote the manuscript. LC, MB and FD'A contributed to the conception and design of the study. MCI, VM, FF, AH, AR, FA, SG, CL, MTC, RAC, GEM and MF participated in the data collection. FD'A analysed the data. MCapitani, MF, MCameli, SV and MB critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.