Support for the Resumption of Training of High-level Athletes Post-epidemic COVID-19 (ASCCOVID19)
22 juni 2021 uppdaterad av: University Hospital, Bordeaux
As of March 2020, COVID-19 has become a global pandemic, halting athletic competition worldwide.
Reports from China show a high prevalence of cardiac involvement in patients with severe SARS-CoV-2 infection. These cardiac forms were found to be closely associated with adverse outcomes. The use of Magnetic resonance Imaging (MRI) had allowed to show that cardiac dysfunction could be mediated by myocardial inflammation (i.e. myocarditis). The direct implication of the virus was demonstrated with Severe Acute Respiratory Syndrome (SARS)-CoV-2 being detected on myocardial biopsies in a patient with severe heart failure.
The experience with other viruses causing acute myocarditis shows that there is a high rate of undetected injuries. Indeed, although severe heart failure can be present at the acute stage, acute viral myocarditis is most commonly pauci or asymptomatic, but still leaving occult myocardial scars visible on MRI, and exposing to higher risks of ventricular arrhythmia and sudden cardiac death over the long term.
Although athletes are younger and have fewer comorbidities than the general population and therefore are at lower risk for severe disease or death, there is a critical and urgent need to assess the prevalence of occult scars in the population of high-level athletes returning to training after the SARS-CoV-2 pandemia.
Studieöversikt
Status
Avslutad
Studietyp
Interventionell
Inskrivning (Faktisk)
984
Fas
- Inte tillämpbar
Kontakter och platser
Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.
Studieorter
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Angoulême, Frankrike, 16000
- Training center Soyaux Angoulême XV Rugby
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Aurillac, Frankrike, 15000
- Training Center Stade Aurillacois
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Bayonne, Frankrike, 64104
- Aviron Bayonnais Rugby Pro Training Center
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Biarritz, Frankrike, 64200
- Biarritz Olympique Pays Basque training center
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Bordeaux, Frankrike, 33076
- Bordeaux University Hospital - CRB medical office - Hôpital du Tondu
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Bordeaux, Frankrike, 33076
- Bordeaux University Hospital - Service UDH - Hôpital Pellegrin
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Brive-la-Gaillarde, Frankrike, 19100
- CABCL Rugby Training Center
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Bègles, Frankrike, 33130
- Union Bordeaux-Bègles training center
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Carcassonne, Frankrike, 11000
- US Carcassonne Rugby training center
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Colomiers, Frankrike, 31770
- Union Sportive Colomiers Rugby training center
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Grenoble, Frankrike, 38100
- FC Grenoble Rugby training center
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La Rochelle, Frankrike, 17000
- Stade Rochelais Rugby training center
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Le Plessis-Robinson, Frankrike, 92350
- Racing92 training center
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Montauban, Frankrike, 82000
- AS Montauban Rugby training center
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Nevers, Frankrike, 58000
- US Nevers Rugby training center
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Paris, Frankrike, 75016
- Stade Français training center
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Pau, Frankrike, 64000
- Section Paloise Rugby training center
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Perpignan, Frankrike, 66000
- USAP Training Center
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Romans-sur-Isère, Frankrike, 26100
- Training center Valence Romans Drôme Rugby
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Saix, Frankrike, 81710
- Castres Olympique training center
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Toulouse, Frankrike, 31200
- Stade Toulousain Rugby training center
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Deltagandekriterier
Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.
Urvalskriterier
Åldrar som är berättigade till studier
18 år och äldre (Vuxen, Äldre vuxen)
Tar emot friska volontärer
Ja
Kön som är behöriga för studier
Allt
Beskrivning
Inclusion Criteria:
- High level athlete,
- Of both sexes and age ≥ 18 years,
- Affiliated to or beneficiary of a social security system,
- Free, informed, written consent signed by the participant and the investigating physician (no later than the day of inclusion and before any examination required by the research),
- Effective method of contraception for women with childbearing capacity.
Exclusion Criteria:
- Minor,
- History of ventricular arrhythmia, myocarditis, identified coronary artery disease or documented myocardial fibrosis,
- Pregnant or breastfeeding women,
- Person unable to give informed consent,
- Person deprived of liberty by judicial or administrative decision,
- Adults subject to a legal protection measure (guardianship, curator, safeguard of justice).
Specific exclusion criteria for the MRI component (Contraindications):
- Subject with an implantable pacemaker or defibrillator, intraocular metallic foreign body, intracranial metallic clip, pre 6000 Starr-Edwards type cardiac valve prosthesis, or biomedical device such as insulin pump or neurostimulator,
- Hypersensitivity to gadolinium or to one of the excipients of the contrast product used,
- Claustrophobic subjects or those unable to remain in an immobile lying position for 30 minutes,
- Renal insufficiency with creatinine clearance of less than 30 ml/min,
- A patient whose shoulder width does not allow installation in the MRI machine.
Studieplan
Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Förebyggande
- Tilldelning: N/A
- Interventionsmodell: Enskild gruppuppgift
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
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Experimentell: High-level athletes
High level athletes are rugby players, intervention unit agents of the National Police, sports students. Definition of a COVID-19 positive subject : Any subject whose serology is positive (IgM and/or IgG) and/or the Reverse Transcription Polymerase Chain Reaction (RT-PCR) result is positive and/or the questionnaire is positive and/or a new electrocardiogram (ECG) abnormality. The COVID-19 negative subjects do not meet the definition of COVID-19 positive subjects. |
An ECG at rest is performed for all participants at Day 0. A centralized reading is performed by one of the 6 expert cardiologists participating in the research.
In case of positive COVID-19 serology and/or positive COVID-19 RT-PCR and/or new ECG abnormality and/or positive questionnaire, a stress test is performed.
In case of positive COVID-19 serology and/or positive COVID-19 RT-PCR and/or new ECG abnormality and/or positive questionnaire, a Cardiac echocardiography is performed.
In case of positive COVID-19 serology and/or positive COVID-19 RT-PCR and/or new ECG abnormality and/or positive questionnaire, a Cardiac rhythm monitoring is performed.
To determine the rhythmic risk of athletes
High resolution MRIs is performed on 200 athletes :
For all athletes included at the D0 inclusion visit, a centralized COVID-19 serology is performed to search for biomarkers associated with the occurrence of myocardial fibrosis: analysis of genetic determinants in relation to cardiac damage. For athletes who have performed MRI: Search for biomarkers associated with the occurrence of myocardial fibrosis: analyses of low-grade inflammation markers (cytokine assay and fibrosis markers). |
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Presence of rhythmic risk markers bye the questionnaire
Tidsram: Day 0
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Questionnaire looking for heart palpitations, chest pain/pressure and shortness of breath.
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Day 0
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Evaluation by resting ECG of rhythmic risk marker : repolarization disorders
Tidsram: Day 0
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Presence or absence of repolarization disorders
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Day 0
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Evaluation by resting ECG of rhythmic risk marker : inverted T waves
Tidsram: Day 0
|
Presence or absence of inverted T waves
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Day 0
|
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Evaluation by resting ECG of rhythmic risk marker : ST segment abnormalities
Tidsram: Day 0
|
Presence or absence of ST segment abnormalities
|
Day 0
|
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Evaluation by resting ECG of rhythmic risk marker : QRS fragmentation
Tidsram: Day 0
|
Presence or absence of QRS fragmentation
|
Day 0
|
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Evaluation by resting ECG of rhythmic risk marker : ventricular extrasystoles (VES)
Tidsram: Day 0
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Presence or absence of VES.
Ventricular extrasystoles especially with short coupling (<300ms), falling on the T wave, width > 160ms, complex forms (repetitive, several morphologies, instantaneous cycle >200bpm)
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Day 0
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Evaluation by resting ECG of rhythmic risk marker : ventricular tachycardia (VT)
Tidsram: Day 0
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Presence or absence of VT.
|
Day 0
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Presence of rhythmic risk markers bye the stress test
Tidsram: Day 0
|
VES, especially with short coupling (<300ms), falling on the T wave, width > 160ms, complex shapes (repetitive, several morphologies, instantaneous cycle >200bpm), ventricular tachycardias (VT).
The analysis focus on the exercise period, and the recovery period.
Ventricular arrhythmias will be quantified.
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Day 0
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Presence of rhythmic risk markers bye ECG holter
Tidsram: Day 0
|
VES, especially with short coupling (<300ms), falling on the T wave, width > 160ms, complex shapes (repetitive, multiple morphologies, instantaneous cycle >200bpm), ventricular tachycardias (VTs).
Ventricular arrhythmias are quantified.
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Day 0
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Presence of rhythmic risk markers bye ECG monitoring during games and trainings
Tidsram: Day 0
|
In case of moderate arrhythmia on stress test and/or Holter ECG, ECG monitoring during training sessions and matches is carried out with analysis of the tracings collected, in search of more sustained arrhythmia, particularly at the ventricular level.
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Day 0
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Presence of rhythmic risk markers by pharmacological tests and/or electrophysiological exploration
Tidsram: Day 0
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If the risk is perceived as very high, pharmacological tests (Isuprel®) and/or electrophysiological exploration may be performed during hospitalization, in search of dangerous rhythm disorders, particularly at the ventricular level.
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Day 0
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Presence of myocardial fibrosis by injected MRI
Tidsram: Month 3
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In order to compare the prevalence of myocardial fibrosis between COVID-19 positive and COVID-19 negative individuals in high level athletes with or without rhythmic risk, a high resolution MRI is performed.
The examinations is performed on 1.5 or 3T MRI systems equipped with specific antennas for cardiology.
The sequence used to detect occult scars is a late enhancement sequence performed at least 15 minutes after injection of gadolinium salts, using a free-breathing 3D method, for a minimum spatial resolution of 2.5x1.25x1.25mm.
The images are reviewed by a core lab at the Bordeaux University Hospital.
The presence or absence of myocardial fibrosis is evaluated.
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Month 3
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Presence of transmural localization of myocardial fibrosis by injected MRI
Tidsram: Month 3
|
In order to compare the prevalence of myocardial fibrosis between COVID-19 positive and COVID-19 negative individuals in high level athletes with or without rhythmic risk, a high resolution MRI is performed.
The examinations is performed on 1.5 or 3T MRI systems equipped with specific antennas for cardiology.
The sequence used to detect occult scars is a late enhancement sequence performed at least 15 minutes after injection of gadolinium salts, using a free-breathing 3D method, for a minimum spatial resolution of 2.5x1.25x1.25mm.
The images are reviewed by a core lab at the Bordeaux University Hospital.
The presence or absence of transmural localization is evaluated.
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Month 3
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Measurement of cardiac scar size by injected MRI
Tidsram: Month 3
|
In order to compare the prevalence of myocardial fibrosis between COVID-19 positive and COVID-19 negative individuals in high level athletes with or without rhythmic risk, a high resolution MRI is performed.
The examinations is performed on 1.5 or 3T MRI systems equipped with specific antennas for cardiology.
The sequence used to detect occult scars is a late enhancement sequence performed at least 15 minutes after injection of gadolinium salts, using a free-breathing 3D method, for a minimum spatial resolution of 2.5x1.25x1.25mm.
The images are reviewed by a core lab at the Bordeaux University Hospital.
The size of scars is measured in milliliters (mL).
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Month 3
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Search for constitutional genetic biomarkers
Tidsram: Month 5
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identification by sequencing of genetic variants that could have an impact on the occurrence of a severe form in individuals infected with SARS-CoV-2.
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Month 5
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Research of inflammation markers
Tidsram: Month 5
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Th1/Th2/activation/inflammation/apoptosis markers are measured in sera by a Luminex test allowing the detection of 10 analytes with a commercial kit according to the manufacturer's instructions
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Month 5
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Samarbetspartners och utredare
Det är här du hittar personer och organisationer som är involverade i denna studie.
Sponsor
Utredare
- Studiestol: Antoine BENARD, MD, University Hospital, Bordeaux
- Huvudutredare: Laurent Chevalier, MD, Medical Center of the Bordeaux-Mérignac Sports Clinic
Publikationer och användbara länkar
Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.
Studieavstämningsdatum
Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.
Studera stora datum
Studiestart (Faktisk)
18 juni 2020
Primärt slutförande (Faktisk)
2 mars 2021
Avslutad studie (Faktisk)
2 mars 2021
Studieregistreringsdatum
Först inskickad
2 juni 2021
Först inskickad som uppfyllde QC-kriterierna
22 juni 2021
Första postat (Faktisk)
23 juni 2021
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
23 juni 2021
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
22 juni 2021
Senast verifierad
1 juni 2021
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- CHUBX 2020/16
Läkemedels- och apparatinformation, studiedokument
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