Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes

Abstract

There is still some controversy about the benignity of structural changes observed in athlete’s heart, especially regarding the observation of increased biomarkers and the presence of myocardial fibrosis (MF).AimOur purpose was to evaluate by cardiovascular magnetic resonance (CMR) the presence of diffuse as well as focal MF in a series of high-performance veteran endurance athletes.MethodsThirty-four veteran healthy male endurance athletes, still being in regular training, with more than 10 years of training underwent a CMR. A cardiopulmonary exercise test was also performed to assess their maximal physical performance. The control group consisted in 12 non-trained normal individuals.ResultsWe found an increase in both, right and left ventricular (LV) volumes in the athlete’s group when compared with controls. There was no increase in indexed LV myocardial mass despite of a significantly increased maximal myocardial wall thickness in comparison to controls. Native T1 values and extracellular volume (ECV) were normal in all cases. We did not find differences in native T1 values and ECV between both groups. In three athletes (9%), non-ischaemic late gadolinium enhancement (LGE) was observed. We did not find a correlation between total training volume and presence of LGE or with the ECV value.ConclusionsOur results show that the majority of veteran endurance athletes present with myocardial remodelling without MF as a physiological adaptive phenomenon. In the only three athletes with focal MF, the LGE pattern observed suggests an intercurrent event not related with the remodelling phenomenon.

Absence of cardiac damage induced by long-term intensive endurance exercise training: A cardiac magnetic resonance and exercise echocardiography analysis in masters athletes

“…typically > 35 yrs). We found a harmonious dilatation of the 2 ventricles, and a moderate increase in total ventricular mass, in accordance with previous description of athlete's heart syndrome in master athletes [17] . Values for these parameters did not exceed the pathological thresholds hypertrophic cardiomyopathy [29] .…”

“…However, it is under debate whether the cumulative effects of intensive endurance exercise induce chronic cardiac damage [3] , [4] , [5] , especially in master athletes. It has been proposed that long-term endurance exercise may be associated with myocardial fibrosis (MF) detected by late gadolinium-enhancement (LGE) cardiac magnetic resonance (CMR) [6] , [7] , [8] , [9] , [10] , [11] , and/or with right ventricle contractile dysfunction [12] , creating a potential substrate for ventricular arrhythmia [13] , but these aspects are not constantly found across studies [14] , [15] , [16] , [17] , [18] .…”

Factors Related to Cardiac Troponin T Increase after Participation in a 100 Km Ultra-Marathon

“…This can help in the differential diagnosis in this group of patients if deemed necessary [5,7]. Finally, presented observations may help to explain the paradox between cardiac troponin increase after the endurance physical activity and lack of permanent myocardial injury in life-long elite runners observed in other studies [4,6,7,[13][14][15]. As the increase in troponin concentration even after an extremely long race is very mild is it unlikely that it can lead to significant myocardial fibrosis.…”

“…Troponin rise after exercise is 2 of 9 usually discrete with levels returning to reference values within hours [8] and may be accompanied by an increase of natriuretic peptide levels and transient decrease of left or right ventricular systolic function without long-term consequences [9][10][11][12]. In line with that, recent studies with new imaging techniques demonstrated that intensive endurance training does not seem to promote myocardial fibrosis [6,[13][14][15].…”

Cardiovascular Magnetic Resonance Imaging and Heart Failure

“…In a study of 50 patients with HCM, 40 athletes, and 35 sedentary volunteers, the T1 values and ECV of the thickest segment in athletes were lower than HCM [ 86 ]. Most of the studies showed there were no significant differences in terms of T1 mapping and ECV between athletes and controls [ 87 , 88 ].…”