Objectives: To clarify the meaning of elevated cardiac troponin in elite football athletes previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and screened for cardiovascular involvement in the wake of competitive sport resumption. Methods: We designed a retrospective cohort study with the collaboration of two Italian Serie A teams. Football players from both rosters (58 athletes) were systematically analysed. For every SARS-CoV-2 positive athlete, the Italian Football Federation protocol requested full blood tests including high-sensitivity cardiac troponin I (hscTnI), along with a complete cardiovascular examination. We extended the analysis to SARS-CoV-2 negative athletes. Results: A total of 13/58 players (22.4%) suffered from SARS-CoV-2infection: all had a negative cardiovascular examination and 2/13 (15%) showed increased hs-cTnI values (120,8 pg/ml and 72,6 pg/ml, respectively; upper reference level 39,2 pg/ml), which did not track with inflammatory biomarkers. Regarding the 45/58 (77,6%) non infected athletes, a slight increase in hs-cTnI was observed in 2 (4.5%) subjects (values: 61 pg/ml and 75pg/ml respectively). All hs-cTnI positive athletes (4/58, 7%) underwent cardiac magnetic resonance (CMR), that excluded any cardiac injury. Conclusions: In our retrospective study, SARS-CoV-2 infection in elite football athletes was not associated to clinical or biomarkers abnormalities. Increased hs-cTnI was rare and not significantly associated with previous SARS-COV2 infection nor with pathological findings at CMR, albeit elevated hs-cTnI was numerically more prevalent in the infected group. Highlights: • The meaning of elevated cardiac troponin in elite athletes previously infected with coronavirus disease 2019 (COVID-19) is today unknown. • In elite football players with previous COVID-19 infection, increased hs-cTnI has been not associated to abnormalities at electrocardiogram and echocardiography, nor at cardiac magnetic resonance imaging. • In elite athletes with previous COVID-19 infection, the cardiac magnetic resonance imaging may exclude an ischemic or myocarditis-related myocardial damage.
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