JCMR 2020;22:62. Prevalence and pattern of myocardial late enhancement in cardiac magnetic resonance of highly trained endurance athlete-jcmr-artilce-2020-22-62

jcmr-artilce-2020-22-62

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This study examined contrast cardiac magnetic resonance (CMR) findings in 93 highly trained endurance athletes (training at least 12 hours/week for 5+ years) and 72 age- and gender-matched controls. The athletes were young, asymptomatic triathletes without known cardiovascular disease.<br /><br />As expected, athletes showed typical “athlete’s heart” remodeling: larger left and right ventricular volumes, larger atrial sizes, and slightly lower resting biventricular ejection fractions than controls. These changes were seen in both men and women.<br /><br />The major finding was that focal late gadolinium enhancement (LGE), a CMR marker often associated with myocardial fibrosis, was much more common in athletes than in controls: 37.6% vs 2.8%, about a ten-fold increase. Importantly, in all athletes the LGE had the same limited pattern: small focal enhancement confined to the right ventricular insertion points, especially the inferior interventricular septum (hinge points). No ischemic-like or more diffuse pathological LGE patterns were observed.<br /><br />In a subgroup of 28 athletes who also underwent T1 mapping, overall extracellular volume (ECV) was within normal limits, but athletes with LGE had slightly higher remote myocardial ECV than those without LGE. This suggests possible more global matrix remodeling, although the values were still normal.<br /><br />There were no major differences in cardiac volumes, function, or exercise capacity between athletes with and without LGE. The authors conclude that this specific LGE pattern may represent another feature of the athlete’s heart, possibly related to mechanical stress from long-term endurance training. However, its clinical and prognostic significance remains unknown and needs long-term follow-up studies.

Keywords

contrast cardiac magnetic resonance

endurance athletes

late gadolinium enhancement

athlete's heart

myocardial fibrosis

right ventricular insertion points

triathletes

T1 mapping

extracellular volume

cardiac remodeling