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Should athletes undergo cardiac MRI before the rematch?



Josh Peter

| USA Today

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The sudden closure of Florida basketball player Keyontae Johnson this month has deepened Adama Washington’s belief that even if his daughter is spared the same fate-if not death.

Demi Washington, a second-year Vanderbilt University basketball player, announced on Twitter on December 7 that she will be absent for the remainder of the season. She revealed that she has been diagnosed with myocarditis, which is a potentially fatal inflammation of the heart associated with COVID-19.

According to Adama Washington, the abnormality was detected by cardiac magnetic resonance imaging (MRI) after the other three tests failed to detect any abnormalities. However, she said that she may have saved her daughter’s heart MRI examination, which is not mandatory in most college meetings. The Big Ten and Big Twelve are the only power five meetings that require athletes who test positive for COVID-19. Perform this test.

Cardiovascular Director Dr. Aaron Baggish said: “There is a belief that cardiac MRI is the gold standard for diagnosing myocarditis, and this belief is based on the fact that it is the best tool for finding heart damage. Massachusetts General Hospital Heart Center Performance plan. “But it’s not a perfect tool.

“Therefore, there will be overreading, and there will be underreading. This will mean that some athletes will be required to sit still and lose valuable game time and visibility, and in some cases, even lose their participation in the draft due to inaccurate reading. Opportunity. But this is the price we need to be conservative.

From Adama Washington’s perspective, the price is much higher: during the coronavirus pandemic, the gold standard medical test may be the difference between life and death for athletes (such as a 19-year-old daughter).

According to the Myocarditis Foundation, myocarditis is responsible for 22% of sudden deaths in athletes under 35.

Dr. Chris Kroenke, chief team physician at the University of Tennessee and member of the US Securities and Exchange Commission’s Medical Guidance Working Group, told USA Today Sports that this meeting requires an electrocardiogram, echocardiogram, and blood test-a widely accepted test for COVID. Screening program for positive athletes-19- and perform cardiac MRI examination according to the specific situation.

However, Eric Dolan, Vanderbilt’s director of men’s and women’s basketball communications, said that Vanderbilt performed a cardiac MRI on Washington because it was part of the school’s agreement for all athletes who tested positive for COVID-19. .

Adama Washington, an adjunct professor at North Carolina State University’s School of Social Work, said: “I think this saved my child’s life because she can easily return to the court to play basketball (with undetected myocarditis).” “We absolutely want to. This can be summed up in a nutshell, because in many universities with COVID, many of our friends’ children are student athletes, and some schools do not perform cardiac MRI examinations.”

Communications Director Dolan said that Demi Washington, who played in 29 of 30 games as a freshman last season, could not be interviewed.

She is the daughter of Dewayne Washington. Dewayne Washington is a retired NFL guard who served as a first-round pick in the 1994 NFL Draft and played for 12 seasons. He said: “I’m just praying that everyone will reach the next level and undergo a cardiac MRI.” “This is obviously crucial.”

Johnson’s family and the State of Florida have hardly disclosed details about the 21-year-old’s car accident, which occurred in a game in Florida on December 12.

According to first-hand people familiar with the matter, Gainesville Sun of USA Today reported on December 22 that Johnson had previously suffered from COVID-19 and had undergone an MRI examination after the crash. Diagnosed with myocarditis. Due to the sensitivity of the situation, this person speaks anonymously.

It is not known when Johnson contracted COVID-19, if his myocarditis was related to COVID-19, and whether he had a cardiac MRI before returning to the game.

Denver Parler, the head of media relations for the Florida basketball team, told USA TODAY Sports via email: “For now, we can only share the latest news from the Keyontae family.”

The college basketball community, including Kentucky men’s coach John Calipari, has been calling for detailed information.

Calipari said on December 17: “I hope if there is something related to COVID, they will tell us because I have a few children who have eaten it earlier.” If it is related to COVID, I will say Every coach wants to know whether to do this. “

After 10 days in the hospital and four more days off, Johnson is expected to be the first-round pick of the NBA draft. He returned to the team on Sunday as a coach. Gators coach Mike White will not say whether Johnson has a chance to play again this season.

Dermot Phelan, a cardiologist with the NFL Reconnaissance Team and Carolina State Cardiologist, said: “I think we need to be very careful about specific situations, especially in Florida, because we are not sure what tests he actually did after he got COVID.” Panthers , Is also the medical director of cardiovascular imaging at the Sanger Heart and Vascular Institute. “We don’t have all the details.”

Medical story. Financial story.

The concern about myocarditis was an important factor in the August Big Ten and Pac-12’s announcement that they would not participate in football matches in the fall. The decisions of both meetings were overturned a few weeks later.

Feilan said that there is still a lot to learn about the link between COVID-19 and myocarditis and the value of cardiac MRI.

Phelan said: “Myocarditis can be a devastating disease, and we really have to take it seriously, which is why we were very cautious in the beginning.” “But the reality is that we don’t see (myocarditis) as common when we look When it comes, people usually have obvious symptoms. Therefore, we really feel that extensive MRI examinations for people who have no suspected myocarditis actually do more harm than good.”

Phelan said, for example, cardiac MRI is a limited resource.

He said: “If we were to perform MRI on every athlete, we would not be able to perform MRI on people who really need their clinical problems.”

Feilan said another problem is the lack of technical expertise.

He said: “In the United States, there are not many places that can be used, and more importantly, there is no professional knowledge that can explain many of the characteristics of MRI that we use to define myocarditis.” “Of course I participated in the second opinion case that athletes do not have myocarditis.”

Baggish is also a cardiologist for the New England Patriots. He said he is familiar with Johnson’s situation and warned people not to associate the player’s collapse and subsequent myocarditis with COVID-19.

“Please forgive my French, but it’s terrible (vulgar),” Bagish said. “Everyone has forgotten that before COVID, young people died, and there is often no good explanation. It’s just that sometimes the heart is a fickle organ, misbehaving, bad things happen.

Phelan said that another problem is the cost. It is estimated that the cost of a cardiac MRI examination is between 2,500 and 8,500 US dollars, which is far more expensive than EKG, echocardiography or blood tests.

“So, there is a medical story and a financial story,” Bagish said. “Schools that do more are always schools with higher sports budgets. In many cases, TV rights will bring them a lot of income.”

According to Baggish, this is very different in smaller I, II, and III schools.

He said: “Some of these schools are barely able to assemble a sports trainer, let alone do a $2,500 exam for every athlete who returns to campus.”

“Inconsistent”

Then there is a medical story that coincides with the beginning of the pandemic.

Baggish said that in February and March, he and other cardiologists found that one-third of COVID-19 patients had evidence of heart damage, which caused serious problems.

What does this mean for young and healthy people who get COVID-19 without hospitalization?

Will young athletes have heart problems? If so, will they put them in danger when they return to the stadium?

Baggish said that in April he and other cardiologists compiled the first set of recommendations for “return to the game” screening of athletes who tested positive for COVID-19. Initial position: More testing is better than less testing.

Then comes June and July, followed by the return of professional and tertiary athletes.

Baggish said: “We conducted a lot of tests, but did not find any (cases of myocarditis), with very few exceptions.” “We found very few cases thought to be related to heart involvement.”

Therefore, Bagghish said that he and his team revised the guidelines again: young, healthy people with mild or asymptomatic symptoms can participate in sports without further testing. Young people with moderate to severe symptoms should undergo a triple examination-echocardiogram, electrocardiogram and blood tests. Moreover, cardiac MRI should be performed only if there is any abnormality in the examination.

“This is where university conferences really start to change their approach,” Bagish said. “This is entirely a university problem.”

The tenth and twelfth universities must undergo cardiac MRI examinations.

ACC, Pac-12 and SEC do not.

This has also become part of the research.

Ohio, Vanderbilt and West Virginia have released athlete test data.

Baggish said: “There is no consistency between the results.”

“You don’t take these things for granted”

For example, in August, Georgia State University freshman quarterback Mikele Colasurdo announced that he would not participate in the 2020 season.

However, when a cardiac MRI showed that his heart injury recovered faster than expected, he was relieved of practice and was finally sent to the field in the fourth quarter of the LendingTree Bowl in Mobile, Alabama last Saturday.Before the game, he only tried two passes and none of them finished

In the bowl, Cora Suldo threw a 25-yard touchdown to help Georgia State University beat Western Kentucky 39-21.

“A little bit of filming is really special to me,” Colasurdo told USA Today. “You no longer take these things for granted. When it is taken away, you will appreciate it more.

“I think this is a major issue of COVID. Usually, no one really knows, do you know? Before you figure this out, it is important that athletes in particular complete this type of test and really figure out whether it is safe to return.”


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