Myocardial Late Gadolinium Enhancement: Prevalence, Pattern, and Prognostic Relevance in Marathon Runners

Abstract

Ostensibly healthy marathon runners have an unexpectedly high rate of myocardial LGE, and this may have diagnostic and prognostic relevance.

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

“…[18][19][20]28 Of concern, accumulating information suggests that some of the remodeling that occurs in endurance athletes may not be entirely benign. 17,[29][30][31][32] For example, in elite athletes, cardiac dimensions do not completely regress to normal levels even several years after the athlete has retired from competition and heavy ET. 33 …”

“…46 This RV dysfunction is likely induced by recurrent extreme and sustained highlevel PA, with marked elevations in pulmonary artery pressures of up to 80 mm Hg in some athletes, 9 which eventually may cause scattered areas of myocardial injury (as evidenced by the increases in troponin) with subsequent fibrotic scarring, typically in the RV and atria. 17,22,23,29,31,32 These observations have led to speculation about the existence of a syndrome of exercise-induced arrhythmogenic RV cardiomyopathy that shares some features with the familial RV disease but is caused by chronic high-level endurance ET rather than a genetic predisposition. 9 Another study using MRI to assess the effects of long-term very long distance running on myocardial structure 31 comprised 102 ostensibly healthy male runners ranging in age from 50 to 72 years who had completed at least 5 marathons during the previous 3 years, compared with 102 age-matched controls.…”

“…17,22,23,29,31,32 These observations have led to speculation about the existence of a syndrome of exercise-induced arrhythmogenic RV cardiomyopathy that shares some features with the familial RV disease but is caused by chronic high-level endurance ET rather than a genetic predisposition. 9 Another study using MRI to assess the effects of long-term very long distance running on myocardial structure 31 comprised 102 ostensibly healthy male runners ranging in age from 50 to 72 years who had completed at least 5 marathons during the previous 3 years, compared with 102 age-matched controls. 31 Approximately 12% of these apparently healthy marathon runners have evidence of patchy myocardial scarring, manifested as late gadolinium enhancement; this was 3-fold more common than in age-matched controls.…”

“…9 Another study using MRI to assess the effects of long-term very long distance running on myocardial structure 31 comprised 102 ostensibly healthy male runners ranging in age from 50 to 72 years who had completed at least 5 marathons during the previous 3 years, compared with 102 age-matched controls. 31 Approximately 12% of these apparently healthy marathon runners have evidence of patchy myocardial scarring, manifested as late gadolinium enhancement; this was 3-fold more common than in age-matched controls. Of additional concern, the CHD event rate during 2-year follow-up was significantly higher in the marathon runners than in controls (PϽ.0001).…”

Phidippides Cardiomyopathy: A Review and Case Illustration

“…13 Right heart dilation and hypokinesis after prolonged strenuous exercise has been observed using cardiac magnetic resonance imaging. 8,14 Diastolic dysfunction is frequently observed in both younger and older athletes. 15 Multiple cardiac biomarkers are released, including myoglobin, cardiac troponin-I, creatine kinase, and creatine kinase myocardial band, and B-type natriuretic peptide.…”