Assessment of myocardial changes in athletes with native T1 mapping and cardiac functional evaluation using 3 T MRI

Abstract

Intensive physical exercise leads to increases in left ventricular muscle mass and wall thickness. Cardiac magnetic resonance imaging allows the assessment of functional and morphological changes in an athlete's heart. In addition, a native T1 mapping technique has been suggested as a non-contrast method to detect myocardial fibrosis. The aim of this study was to show the correlation between athletes' cardiac modifications and myocardial fibrosis with a native T1 mapping technique. A total of 41 healthy non-athletic control subjects and 46 athletes underwent CMR imaging. After the functional and morphological assessments, native T1 mapping was performed in all subjects using 3.0 T magnetic resonance imaging. Most of the CMR findings were significantly higher in athletes who had ≥5 years of sports activity when compared with non-athletic controls and athletes who had <5 years of sports activity. Significantly higher results were shown in native T1 values in athletes who had <5 years of sports activity, but there were no significant differences in the left ventricular end-diastolic volume, left ventricular end-diastolic mass, or interventricular septal wall thickness between non-athletic controls and athletes who had <5 years of sports activity. The native T1 mapping technique has the potential to discriminate myocardial fibrotic changes in athletes when compared to a normal myocardium. The T1 mapping method might be a feasible technique to evaluate athletes because it does not involve contrast, is non-invasive and allows for easy evaluation of myocardial remodeling.

Myocardial Fibrosis in Athletes

“…Moreover, athletes reporting at least 5 years of exercise training had higher T1 values, indicating more diffuse fibrosis compared with athletes exercising for less than 5 years (P<.05). 51 These findings suggest a higher prevalence of diffuse MF in Turkish athletes vs controls. Apart from the age difference between Scottish (mean AE SD age, 46AE11 years) and Turkish (mean AE SD age, 25AE3 years) athletes, there is no clear explanation for the conflicting outcomes.…”

“…Nevertheless, 2 recent studies used T1 and T2 mapping to assess (diffuse) MF in athletes. 8,51 In a Scottish study, no difference in native T1, T2 relaxation time and extracellular volume was observed between athletes (n¼21, !6 h/wk of exercise training) and controls (n¼21). 8 In contrast, significantly higher native T1 values of the LV and interventricular septum were found in Turkish athletes (!6 h/wk intense exercise training) compared with age-and sex-matched controls (<3 h/wk moderate exercise).…”

The “Extreme Exercise Hypothesis”: Recent Findings and Cardiovascular Health Implications

“…Whereas previous studies predominantly employed gadolinium infusion to determine focal fibrosis, T1 mapping is increasingly used to quantitate diffuse fibrosis (Table 1 ). Gormeli et al found that athletes had significantly higher left ventricular (LV) native T1 values (1230 ± 39 ms versus 1174 ± 36 ms, p < 0.001) and interventricular septum (IVS) native T1 values (1268 ± 48 ms versus 1180 ± 27 ms, p < 0.001) compared to matched sedentary controls [ 37 ]. Furthermore, native T1 values of the LV ( p < 0.05) and IVS ( p < 0.05) were significantly higher in athletes that trained ≥ 5 years as compared to those training < 5 years, and the highest values of LV end diastolic volume and IVS wall thickness were found in those athletes who had trained the longest.…”

Global And Regional Cardiac Function In Lifelong Endurance Athletes With And Without Myocardial Fibrosis

“…This means that it is extremely hard to recruit a larger sample size. Further work utilising T1 mapping sequences to image interstitial fibrosis may prove promising in athletic heart assessment (Gormeli et al, 2016).…”