Clinical Outcomes and Prognosis
Gregor Peter, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
Gregor Peter, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
Gunnar K. Lund, MD
MD
University Medical Center Hamburg-Eppendorf, Department of Radiology, Hamburg, Germany
Julian Rodin, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
Martin Sinn, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf
Hamburg , Hamburg, Germany
Kai Muellerleile, MD
Senior Physician
University Medical Center Hamburg-Eppendorf, Germany
Ersin Cavus, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf
Hamburg, Hamburg, Germany
Stefan Blankenberg, MD
Director of the Cardiology Department
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Christian Stehning, PhD
MRI Physicist
Philips Healthcare, Hamburg, Germany
Monica Patten, MD
Senior Physician
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Axel Pressler, MD
Specialist in Cardiology
Medical Practice "Kardiologie mit Herz", Germany
Gerhard Adam, MD
Director of the Radiology Department
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Maxim Avanesov, MD
Specialist in Cardiology
University Medical Center Hamburg-Eppendorf
Hamburg, Germany
Enver G. Tahir, MD
Senior physician
University Medical Center Hamburg-Eppendorf
Hamburg, Hamburg, Germany
Haissam Ragab, MD
Radiology Resident
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
This study analyzed clinical and cardiac magnetic resonance (CMR) characteristics in male marathon runners with (LGE+) and without (LGE-) late gadolinium enhancement.
Methods:
We studied 55 male marathon runners (44 ±8 years) using clinical parameters as well as late gadolinium enhancement (LGE) and extracellular volume (ECV) imaging. Imaging was performed on a 1.5 T Achieva Scanner (Philips Healthcare). Conventional balanced steady-state free-precession (SSFP) cine imaging in the short axis covering the left ventricle (LV) and right ventricle (RV) was obtained for volumetry and LV mass. A modified look locker inversion recovery (MOLLI) sequence with a 5s(3s)3s scheme on 3 short-axis slices (apical, mid and basal) before and 15 minutes after administration of contrast medium was used to perform T1 mapping and ECV quantification. Additionally, end-diastolic LGE images were acquired with standard phase-sensitive inversion recovery (PSIR) sequences in short axis orientation and in 2-, 3- and 4-chamber views matching cine images. Focal myocardial fibrosis was identified on short- and long-axis LGE images and considered present using a threshold method with a cutoff of more than five SDs above normal myocardium (1). Distribution and pattern of LGE were visually analyzed and reported using a 17-segment model.
Results:
LGE CMR revealed 7 LGE+ out of 55 male runners (15%). LGE+ runners had lower weight (69 ±9 vs 77 ±9 kg, P< 0.05), lower body surface area (1.85 ±0.15 vs 1.97 ±0.14 m², P< 0.05) and lower body mass index (21.7 ±1.9 vs 23.3 ±1.8 kg/m², P< 0.05) compared to LGE- males (Table 1). The heart rate at rest was slightly higher before the exercise test with 60 ±10 beats per minutes compared to LGE- males with 52 ±7 beats per minutes (P< 0.01, Table 2). LV mass was higher in LGE+ males with 86 ±18 g/m2 compared to LGE- runners with 73 ±14 g/m2 (P< 0.05). The competition history revealed that the best marathon finishing time was with 3.2 ±0.3 hours shorter in LGE+ males compared to LGE- males with 3.6 ±0.4 hours (P< 0.05). All other training and competition history parameters were similar in both groups.
Conclusion:
LGE+ males had higher LV mass compared to LGE- males, indicating a more pronounced adaption of the heart to exercise. Furthermore, LGE+ males had lower weight and shorter best marathon finishing time suggesting a better fitness level and higher training load to accomplish the marathon in a short time. The higher training load can explain the higher LV mass and could be one additional cofactor in the genesis of myocardial fibrosis in athletes.