TY - JOUR T1 - COVID-19 viral infection and myocarditis in athletes: the need for caution in interpreting cardiac magnetic resonance findings JF - British Journal of Sports Medicine JO - Br J Sports Med DO - 10.1136/bjsports-2022-105470 SP - bjsports-2022-105470 AU - Alessandro Zorzi AU - Alberto Cipriani AU - Domenico Corrado Y1 - 2022/04/06 UR - http://bjsm.bmj.com/content/early/2022/04/06/bjsports-2022-105470.abstract N2 - Common viral infections may cause a number of acute diseases that involve organ systems outside the respiratory tract, including inflammation of the heart muscle (myocarditis).1 Diagnosis of myocarditis by cardiac magnetic resonance (CMR) traditionally relies on myocardial tissue characterisation abnormalities such as increased signal intensity on T2-weighted sequences (oedema), early gadolinium enhancement (hyperaemia) and late gadolinium enhancement (LGE) (necrosis and/or fibrosis).1 Myocardial T1 and T2 mapping are recent techniques that allow a more accurate characterisation of myocardial tissue changes induced by inflammation.2 According to the 2018 revised ‘Lake Louise’ criteria, diagnosis of myocarditis is fulfilled in the presence of relevant symptoms when at least one of the T1-based criteria plus at least one of the T2-based criteria are met.3At the beginning of the COVID-19 pandemic, there was concern that heart muscle could be more frequently involved by SARS-CoV-2 infection than by other respiratory viruses. In athletes who recovered from COVID-19, a small study on 26 subjects reported 4 (15%) fulfilling Lake Louise criteria for myocarditis and 8 (31%) with isolated LGE,4 while subsequent investigations with larger cohorts of athletes showed a much lower prevalence of myocardial involvement (online supplemental table).Supplementary data[bjsports-2022-105470supp001.pdf]In a recent study in the British Journal of Sports Medicine, Szabó et al5 provided a new piece of evidence on the true incidence of myocardial tissue abnormalities at CMR in athletes who tested positive for SARS-CoV-2. The study had many methodological strengths: a large study population; a comprehensive and updated CMR tissue characterisation protocol, including T1 and T2 mapping; the availability of a subset of athletes with both pre-COVID … ER -