CMR-Analysis (including machine learning)
Julian Rodin, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
Julian Rodin, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
Gunnar K. Lund, MD
MD
University Medical Center Hamburg-Eppendorf, Department of Radiology, Hamburg, Germany
Lynn Breitsprecher
Student
University Medical Center Hamburg-Eppendorf, Germany
Martin Sinn, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf
Hamburg , Hamburg, Germany
Gregor Peter, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
Kai Müllerleile
Professor Dr.
University Medical Center Hamburg-Eppendorf, Germany
Ersin Cavus, MD
Resident Doctor
University Medical Center Hamburg-Eppendorf
Hamburg, Hamburg, Germany
Christian Stehning, PhD
MRI Physicist
Philips Healthcare, Hamburg, Germany
Stefan Blankenberg, MD
Director of the Cardiology Department
University Medical Center Hamburg-Eppendorf, 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 CMR characteristics, including focal and diffuse myocardial fibrosis detected by LGE and ECV imaging in marathon runners compared to controls.
Methods:
Seventy-four marathon runners, including 19 female runners, were enrolled in this study. The mean age was 44 ± 8 years in male runners and 36 ± 7 years in female runners, respectively. Another 36 control subjects with similar distribution of age and sex were included for comparison. CMR 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 three 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. Native T1 and post-contrast T1 were measured using a single ROI drawn in the septum on a mid-cavity short-axis map. ECV was calculated by a standard formula (2). Areas of focal LGE were excluded from T1 and ECV quantification to evaluate these parameters unbiased from the presence of LGE (3).
Results:
Male and female marathon runners demonstrated typical adaption to exercise, including higher maximal power and higher VO2max during exercise testing compared to controls (Table 1). Furthermore, CMR revealed higher LV mass and higher LV and right ventricular (RV) volumes in male and female runners compared to controls (Table 2). Focal LGE was observed in 7 out of 55 male runners (13%) and in one out of 19 female runners (5%). The observed LGE was typically non-ischemic with midmyocardial or subepicardial localization in 7 of 8 runners (88%). ECV was increased in remote myocardium without LGE in male runners (25.5 ±2.3%) compared to male controls (24.0 ±3.0%, P< 0.05), indicating the presence of diffuse myocardial fibrosis.
Conclusion:
Focal LGE occurred more frequently in male marathon runners (13%) than female runners (5%). The observed LGE was typically non-ischemic with midmyocardial or subepicardial localization. The increased ECV of remote myocardium in male runners indicates diffuse myocardial fibrosis in normal appearing myocardium. The observed LGE and ECV findings indicate an abnormal adaption of the heart to exercise and are so far not related to the athlete’s heart.