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Prevalence and pattern of cardiovascular magnetic resonance late gadolinium enhancement in highly trained endurance athletes

  • Domenech-Ximenos, B.1, 2
  • Sanz-de la Garza, M.2, 3
  • Prat-González, S.2
  • Sepúlveda-Martínez, A.4, 5
  • Crispi, F.4
  • Duran-Fernandez, K.2
  • Perea, R. J.1, 2, 3, 4, 5, 6
  • Bijnens, B.6, 7, 8
  • Sitges, M.2, 3
  • 1 Hospital Clinic, Barcelona, Spain , Barcelona (Spain)
  • 2 Cardiovascular Institute, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain , Barcelona (Spain)
  • 3 Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain , Barcelona (Spain)
  • 4 Barcelona University, CIBER-ER, Barcelona, Spain , Barcelona (Spain)
  • 5 Hospital Clínico - Universidad de Chile, Santiago de Chile, Chile , Santiago de Chile (Chile)
  • 6 Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain , Barcelona (Spain)
  • 7 Universitat Pompeu Fabra, Barcelona, Spain , Barcelona (Spain)
  • 8 ICREA, Barcelona, Spain , Barcelona (Spain)
Published Article
Journal of Cardiovascular Magnetic Resonance
Springer (Biomed Central Ltd.)
Publication Date
Sep 03, 2020
DOI: 10.1186/s12968-020-00660-w
Springer Nature


BackgroundIntensive endurance exercise may induce a broad spectrum of right ventricular (RV) adaptation/remodelling patterns. Late gadolinium enhancement (LGE) has also been described in cardiovascular magnetic resonance (CMR) of some endurance athletes and its clinical meaning remains controversial. Our aim was to characterize the features of contrast CMR and the observed patterns of the LGE distribution in a cohort of highly trained endurance athletes.MethodsNinety-three highly trained endurance athletes (> 12 h training/week at least during the last 5 years; 36 ± 6 years old; 53% male) and 72 age and gender-matched controls underwent a resting contrast CMR. In a subgroup of 28 athletes, T1 mapping was also performed.ResultsHigh endurance training load was associated with larger bi-ventricular and bi-atrial sizes and a slight reduction of biventricular ejection fraction, as compared to controls in both genders (p < 0.05). Focal LGE was significantly more prevalent in athletes than in healthy subjects (37.6% vs 2.8%; p < 0.001), with a typical pattern in the RV insertion points. In T1 mapping, those athletes who had focal LGE had higher extracellular volume (ECV) at the remote myocardium than those without (27 ± 2.2% vs 25.2 ± 2.1%; p < 0.05).ConclusionsHighly trained endurance athletes showed a ten-fold increase in the prevalence of focal LGE as compared to control subjects, always confined to the hinge points. Additionally, those athletes with focal LGE demonstrated globally higher myocardial ECV values. This matrix remodelling and potential presence of myocardial fibrosis may be another feature of the athlete’s heart, of which the clinical and prognostic significance remains to be determined.

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