Advances in cardiac imaging: the role of magnetic resonance imaging and computed tomography in identifying athletes at risk

Abstract

Advanced cardiac imaging, using cardiac magnetic resonance imaging (MRI) and multidetector computed tomography (CT), is increasingly used in the work-up of athletes with suspected abnormalities on screening. Both imaging modalities produce highly accurate and reproducible structural and functional cardiac information. Cardiac MRI has the advantage of imaging without radiation exposure or the use of iodine-containing contrast agents, but is sometimes not possible due to claustrophobia or other contraindications. Although cardiac MRI can rule out coronary artery anomalies, multidetector CT is superior to cardiac MRI for visualising the full extent of the coronary arteries and atherosclerotic coronary artery disease. For patients less than 35 years of age, cardiac MRI is the first option after initial echocardiography for further assessment of cardiomyopathies, myocarditis and coronary anomalies, which are major causes of sudden cardiac death in young athletes. For athletes over 35 years of age the most common cause of sudden cardiac death is coronary artery disease, whereby cardiovascular screening requires further diagnostic modalities and may include multidetector CT.

Assessment of Mechanical Cardiac Function in Elite Athletes

“…Furthermore, based on the novel results of our study we suggest that combined ECG and BCG could potentially be used as an inexpensive screening procedure for mass athletic testing to assess cardiac abnormalities [44]. Compromised athletes could then be sent for advanced medical follow-up (Echo, cardiac MRI) as conducted here in an attempt to differentiate the "athletic" heart from a pathological condition [24,46].…”

“…Echocardiography and cardiac MRI are non-invasive techniques that are most specific and sensitive to successfully diagnose athletes with HCM [44][45][46]. However, these techniques are not always available and are expensive to perform, especially for mass testing of athletic teams.…”

Athlete's Heart and Cardiovascular Care of the Athlete

“…The interested reader is referred to a recently published comprehensive review on this topic. 89 At the present time, there is no single diagnostic test with adequate accuracy for differentiating adaptive from pathological cardiomyopathy. Consequently, we encourage clinicians faced with this diagnostic dilemma to begin the assessment with an integrated consideration of personal and family medical history, 12-lead ECG, and echocardiography.…”

Cœur d’athlète

“…L'IRM n'est pas un examen de dépistage ou de première intention pour des raisons évidentes de coût et de disponibilité. Cependant, par ses performances intrinsèques, elle tient une place fondamentale pour l'exploration des sportifs de haut niveau en cas d'anomalie à l'ECG ou d'échocardiographie non concluante [26][27].…”