mesЭкстремальная биомедицинаExtreme Medicine3033-89643033-8972Centre for Strategic Planning of the Federal Medical and Biological Agency10.47183/mes.2023.042mes-46Research ArticleОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕORIGINAL RESEARCHПоражение сердца у юных элитных спортсменов, перенесших COVID-19Heart disease in young elite athletes having a history of COVID-19МакаровЛ. М.MakarovL. M.

Леонид Михайлович Макаров

Москворечье, д. 20, г. Москва, 115409

Leonid M. Makarov

Moskvorechye, 20, Moscow, 115409 

dr.leonidmakarov@mail.ruКомолятоваВ. Н.KomolyatovaV. N.

Москва

Moscow

КиселеваИ. И.KiselyovaI. I.

Москва

Moscow

БеспорточныйД. А.BesportochnyD. A.

Москва

Moscow

АкопянА. Г.AkopyanA. G.

Москва

Moscow

ДмитриеваА. В.DmitrievaA. V.

Москва

Moscow

АксеноваН. В.AksyonovaN. V.

Москва

Moscow

Федеральный научно-клинический центр детей и подростков Федерального медико-биологического агентства; Российская медицинская академия непрерывного профессионального образования Министерства здравоохранения России; Академия постдипломного образования Федерального научно-клинического центра Федерального медико-биологического агентстваРоссияFederal Scientific and Clinical Center for Children and Adolescents of Federal Medical Biological Agency; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation; Academy of Postgraduate Education, Federal Scientific and Clinical Center of Federal Medical Biological AgencyRussian FederationФедеральный научно-клинический центр детей и подростков Федерального медико-биологического агентства; Российская медицинская академия непрерывного профессионального образования Министерства здравоохранения РоссииРоссияFederal Scientific and Clinical Center for Children and Adolescents of Federal Medical Biological Agency; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian FederationRussian FederationФедеральный научно-клинический центр детей и подростков Федерального медико-биологического агентстваРоссияFederal Scientific and Clinical Center for Children and Adolescents of Federal Medical Biological AgencyRussian Federation2023231020242539298Copyright © Макаров Л.М., Комолятова В.Н., Киселева И.И., Беспорточный Д.А., Акопян А.Г., Дмитриева А.В., Аксенова Н.В., 20242024Макаров Л.М., Комолятова В.Н., Киселева И.И., Беспорточный Д.А., Акопян А.Г., Дмитриева А.В., Аксенова Н.В.Makarov L.M., Komolyatova V.N., Kiselyova I.I., Besportochny D.A., Akopyan A.G., Dmitrieva A.V., Aksyonova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.extrememedicine.ru/jour/article/view/46

Влияние коронавирусной инфекции (SARS-CoV-2) на состояние сердца у несовершеннолетних спортсменов остается неопределенным. Целью работы было определение поражения сердца юных элитных спортсменов, перенесших инфекции COVID-19 (SARS-CoV-2). Проведен ретроспективный анализ результатов разработанного трехэтапного медицинского обследования 236 элитных спортсменов 14–17 (16 ± 1) лет, перенесших инфекцию SARSCoV-2. Первый этап обследования включал осмотр, ЭКГ, ЭХО-КГ, велоэргометрию (ВЭМ), оценку КФК и КФК-МВ. В связи с выявленными изменениями 22-м спортсменам (9,3%) на втором этапе проводили более углубленное обследование, включающее холтеровское мониторирование (ХМ) с оценкой турбулентности ритма сердца (ТРС), микровольтной альтернации Т-зубца (МАТ) и вариабельности ритма сердца (ВРС), ЭКГ высокого разрешения (ЭКГ ВР), определение биохимических маркеров поражения миокарда: тропонин, NТproBNP. Семь спортсменов (32%) с выявленными на этом этапе изменениями были направлены на проведение магнитно-резонансной томографии (МРТ) сердца с контрастированием гадолинием (третий этап). По ее результатам в четырех случаях (1,7% из 236) был поставлен диагноз миоперикардит. Таким образом, отмечена низкая (менее 2%) вовлеченность поражения миокарда у юных элитных спортсменов, перенесших инфекцию SARS-CoV-2. Разработан алгоритм обследования сердца таких спортсменов. Наиболее информативно выявление аритмий сердца с помощью ЭКГ, ВЭМ и ХМ. Дополнительными методами определения показаний к МРТ сердца как золотому стандарту диагностики миокардита могут быть методы ЭКГ ВР, ВРС, ТРС и МАТ.

The impact of coronavirus infection (SARS-CoV-2) on cardiac output in underage athletes is uncertain. The study was aimed to determine heart disease in young elite athletes having a history of COVID-19 (SARS-CoV-2). A retrospective analysis of the results of the developed three-phase medical assessment of 236 elite athletes aged 14–17 (16 ± 1), who had had SARS-CoV-2 infection, was performed. The first phase of assessment involved examination, ECG, ECHO, bicycle ergometry (BEM), creatine kinase and creatine kinase MB tests. During the second phase 22 athletes (9.3%) underwent a more thorough assessment that included Holter monitoring (HM) with heart rate turbulence (HRT), microvolt T–wave alternans (MTWA), heart rate variability (HRV) estimation, signal averaged ECG (SAECG), determination of myocardial damage biochemical markers (troponin, NТproBNP) due to alterations revealed. Seven athletes (32%) having alterations revealed during this phase were referred to gadolinium enhancement cardiac magnetic resonance imaging (MRI) (the third phase). Myopericarditis was diagnosed in four cases (1.7% of 236) based on the results. Thus, low myocardial involvement (below 2%) has been revealed in young elite athletes, who have a history of SARSCoV-2 infection. Cardiovascular assessment algorithm has been developed for such athletes. Detection of cardiac arrhythmias by ECG, BEM, and HM is the most informative. SAECG, HRV, HRT, and MTWA can be used as additional methods to determine indications for MRI as a gold standard of the diagnosis of myocarditis.

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The authors declare that there are no conflicts of interest present.