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The role of cardiac magnetic resonance in sports cardiology: results from a large cohort of athletes

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Abstract

Background

Cardiac magnetic resonance (CMR) provides information on morpho-functional abnormalities and myocardial tissue characterisation. Appropriate indications for CMR in athletes are uncertain.

Objective

To analyse the CMR performed at our Institute to evaluate variables associated with pathologic findings in a large cohort of athletes presenting with different clinical conditions.

Methods

All the CMR performed at our Institute in athletes aged > 14 years were recruited. CMR indications were investigated. CMR was categorised as “positive” or “negative” based on the presence of morphological and/or functional abnormalities and/or the presence of late gadolinium enhancement (excluding the right ventricular insertion point), fat infiltration, or oedema. Variables associated with “positive” CMR were explored.

Results

A total of 503 CMR were included in the analysis. “Negative” and “positive” CMR were 61% and 39%, respectively. Uncommon ventricular arrhythmias (VAs) were the most frequent indications for CMR, but the proportion of positive results was low (37%), and only polymorphic ventricular patterns were associated with positive CMR (p = 0.006). T-wave inversion at 12-lead ECG, particularly on lateral and inferolateral leads, was associated with positive CMR in 34% of athletes (p = 0.05). Echocardiography abnormalities resulted in a large proportion (58%) of positive CMR, mostly cardiomyopathies.

Conclusion

CMR is more efficient in identifying a pathologic cardiac substrate in athletes in case of VAs (i.e., polymorphic beats), abnormal ECG repolarisation (negative T-waves in inferolateral leads), and borderline echocardiographic findings (LV hypertrophy, mildly depressed LV function). On the other hand, CMR is associated with a large proportion of negative results. Therefore, a careful clinical selection is needed to indicate CMR in athletes appropriately.

Graphical Abstract

Clinical indications for CMR and positive CMR findings.

The left panel shows clinical indications for CMR in our athletic cohort and the percentage of negative CMRs. In contrast, the right one shows the percentages of positive CMR findings with some examples. The white arrows in the right panel show an ARVD with a dilated right ventricle and multiple aneurysms of its free wall. The red arrows show the distribution of LGE in the left ventricle. The red panel below shows indications associated with positive CMR findings. ARVD, arrhythmogenic right ventricular disease; BAV, bicuspid aortic valve; CMP, cardiomyopathies; CMR, cardiac magnetic resonance; DCM, dilated cardiomyopathy; ECG, electrocardiogram; Echo, echocardiogram; FHx, family history; HCM, hypertrophic cardiomyopathy; LAD, left axis deviation; LBBB, left bundle branch block; LGE, late gadolinium enhancement; LV, left ventricle; LVH, left ventricular hypertrophy; LVNC, left ventricular non-compaction; MVP, mitral valve prolapse; RV, right ventricle; SVAs, supraventricular arrhythmias; VAs, ventricular arrhythmias; VHD, valvular heart diseases; TWI, T-wave inversion.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Institute of Sports Medicine and Science, Italian National Olympic Committee, Largo Piero Gabrielli n 1, 00197, Rome, Italy

    Viviana Maestrini, Marco Penza, Sara Monosilio, Silvia Prosperi, Domenico Filomena, Lucia Ilaria Birtolo, Erika Lemme, Ruggiero Mango, Giuseppe Di Gioia, Gianfranco Gualdi, Maria Rosaria Squeo & Antonio Pelliccia

  2. Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico n 155, 00161, Rome, Italy

    Viviana Maestrini, Sara Monosilio, Silvia Prosperi, Domenico Filomena & Lucia Ilaria Birtolo

  3. Institute of Sports Medicine, Milan, Italy

    Marco Penza

  4. Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy

    Cristian Borrazzo

Authors
  1. Viviana Maestrini
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  2. Marco Penza
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  3. Sara Monosilio
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  8. Erika Lemme
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  9. Ruggiero Mango
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  10. Giuseppe Di Gioia
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  13. Antonio Pelliccia
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Contributions

V.M. and A.P.: conception and design of the work, data acquisition, analysis, writing, reviewing and final approval of the manuscript; S.M, M.P., C.B., S.P., D.F., L.I.B., E.L., G.D.G, R.M., M.R.S. and G.G.: data acquisition, analysis and interpretation of data for the work, writing, reviewing, and final approval of the manuscript.

Corresponding author

Correspondence to Viviana Maestrini.

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Written informed consent was obtained from all subjects (patients) in this study.

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The authors declare no competing interests.

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Maestrini, V., Penza, M., Monosilio, S. et al. The role of cardiac magnetic resonance in sports cardiology: results from a large cohort of athletes. Clin Res Cardiol 113, 781–789 (2024). https://doi.org/10.1007/s00392-024-02447-w

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