{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:06:59Z","timestamp":1777633619188,"version":"3.51.4"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007323","name":"Bundesinstitut f\u00fcr Sportwissenschaft","doi-asserted-by":"publisher","award":["ZMVI4-070106\/20-23"],"award-info":[{"award-number":["ZMVI4-070106\/20-23"]}],"id":[{"id":"10.13039\/501100007323","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Most studies in athletes have focused on short-term outcomes after SARS-CoV-2 infection, whereas long-term data on cardiac function and exercise performance remain limited. This prospective study evaluated 12-month changes in cardiac structure, myocardial deformation, and cardiopulmonary performance in elite and recreational athletes after mild COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Fifty-two athletes (median age 32.5 (24.8\u201346.3) years; 27 females) from endurance, power, and mixed sports underwent echocardiography, cardiopulmonary exercise testing (CPET), and bioimpedance analysis after infection (T0; median 88 days post-infection) and again at 12-month follow-up (T1). Measurements included left and right ventricular global longitudinal strain (LV\/RV GLS), RV free wall strain (FWS), left atrial strain, CPET performance and ventilatory parameters, and anthropometric variables. Longitudinal changes were evaluated using paired comparisons and linear mixed-effects models. Univariable and multivariable regressions were performed to identify predictors of follow-up VO\n                      <jats:sub>2peak<\/jats:sub>\n                      and its longitudinal change.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cardiac structure, LV and RV systolic function, and myocardial deformation remained stable over 12 months, with no evidence of adverse remodeling. A significant reduction in E\/E\u2032 medial was observed at follow-up (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), while all other diastolic indices did not change significantly. Cardiopulmonary performance was preserved, with no significant changes in maximal workload, absolute or relative VO\n                      <jats:sub>2peak<\/jats:sub>\n                      , ventilatory efficiency, or oxygen pulse (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). CPET differences were limited to a higher peak RER (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045) and a lower resting heart rate at T1 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). Body composition changed modestly, with higher BMI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035), while pulmonary function parameters remained stable. In multivariable linear regression, baseline VO\n                      <jats:sub>\u2082peak<\/jats:sub>\n                      was the only independent predictor of follow-up VO\n                      <jats:sub>\u2082peak<\/jats:sub>\n                      (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.92, 95% CI 0.68\u20131.15;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001; R\u00b2\u2009=\u20090.64), whereas sex, sport type, and baseline LV GLS were not associated with performance at T1.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Athletes recovering from mild SARS-CoV-2 infection show no evidence of impaired myocardial structure, strain, or cardiopulmonary performance at 12 months post-infection. Minor variations in diastolic indices and body composition appeared physiological, and baseline aerobic fitness was the strongest predictor of follow-up performance. These findings indicate a stable 1-year cardiopulmonary outcome and support the safety of return to sport in asymptomatic athletes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1776089","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:46:18Z","timestamp":1777437978000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term cardiovascular function and cardiopulmonary performance in athletes after COVID-19: results from the COSMO study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jana","family":"Schellenberg","sequence":"first","affiliation":[{"name":"Sports and Rehabilitation Medicine, University Ulm Hospital","place":["Ulm, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn","family":"Matits","sequence":"additional","affiliation":[{"name":"Sports and Rehabilitation Medicine, University Ulm 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