Long-term Cardiovascular Health and Exercise Capacity Post-COVID-19 in Athletes

Overview

This prospective study of 52 elite and recreational athletes found stable cardiac structure, myocardial deformation, and cardiopulmonary performance 12 months after mild COVID-19 infection. Baseline aerobic fitness was the strongest predictor of follow-up exercise capacity, with no evidence of adverse cardiac remodeling or impaired function.

Background

SARS-CoV-2 infection can cause cardiovascular complications, raising concerns about myocardial injury and impaired cardiac function, especially in athletes where subtle changes may affect performance. While early studies focused on hospitalized or symptomatic patients, athletes typically experience mild disease, and long-term cardiac outcomes remain unclear. Strain imaging is a sensitive method to detect myocardial dysfunction, but data on persistent changes in athletes post-COVID-19 are limited. This study addresses the gap by evaluating 12-month cardiac and exercise capacity changes after mild infection.

Data Highlights

Key Findings

• Cardiac structure and systolic function, including LV and RV global longitudinal strain, remained stable with no adverse remodeling over 12 months.
• A significant reduction in the E/E′ medial diastolic index was observed, indicating possible physiological improvement.
• Cardiopulmonary exercise performance, including maximal workload and VO2peak, was preserved without significant decline.
• Minor changes included higher peak respiratory exchange ratio and lower resting heart rate at follow-up.
• Body composition showed a modest increase in BMI, while pulmonary function remained stable.
• Baseline VO2peak was the only independent predictor of follow-up exercise capacity; sex, sport type, and baseline LV GLS were not predictive.

Clinical Implications

These findings support the safety of return to sport in asymptomatic athletes after mild COVID-19, as no long-term impairment in myocardial function or exercise capacity was observed. Monitoring baseline aerobic fitness may help predict long-term performance outcomes. Minor physiological changes in diastolic function and body composition appear non-pathological and should be interpreted in clinical context.

Conclusion

Athletes recovering from mild SARS-CoV-2 infection demonstrate stable cardiac and cardiopulmonary health at one year post-infection, with baseline fitness strongly predicting long-term exercise capacity. This evidence reassures clinicians and athletes regarding cardiovascular safety during return-to-play decisions.

References

1. COSMO Study Group 2023 -- Assessment of Long-term Cardiovascular Health and Exercise Capacity in Athletes Post-COVID-19