Detection of Cardiovascular Disease in Elite Athletes Using Cardiac Magnetic Resonance Imaging

Abstract

Purpose: Sudden cardiac death [SCD] in competitive athletes is caused by a diverse set of cardiovascular diseases such as hypertrophic and dilated cardiomyopathy [HCM/DCM], myocarditis, coronary anomalies or even coronary artery disease. In order to identify potential risk factors responsible for SCD, elite athletes underwent cardiac magnetic resonance [CMR] imaging.

Materials and Methods: 73 male [M] and 22 female [F] athletes (mean age 35.2 ± 11.4 years) underwent CMR imaging. ECG-gated breath-hold cine SSFP sequences were used for the evaluation of wall motion abnormalities and myocardial hypertrophy as well as for quantitative analysis (left and right ventricular [LV, RV] end-diastolic and end-systolic volume [EDV, ESV], stroke volume [SV], ejection fraction [EF] and myocardial mass [MM]). Furthermore, left and right atrial sizes were assessed by planimetry and delayed enhancement imaging was performed 10 minutes after the application of contrast agent. Coronary arteries were depicted using free-breathing Flash-3 D MR angiography.

Results: The quantitative analyses showed eccentric hypertrophy of the left ventricle (remodeling index [MM/LV-EDV]: M 0.75, F 0.665), enlargement of the RV volumes (RV-EDV: M 122.6 ± 19.0 ml/m², F 99.9 ± 7.2 ml/m²) and an increased SV (LV-SV: M 64.7 ± 10.0 ml/m², F 56.5 ± 5.7 ml/m²; RV-SV; M 66.7 ± 10.4 ml/m², F 54.2 ± 7.1 ml/m²). Abnormal findings were detected in 6 athletes (6.3 %) including one benign variant of coronary anomaly and abnormal late gadolinium enhancement in 2 cases. None of the athletes showed wall motion abnormalities or signs of myocardial ischemia.

Conclusion: CMR imaging of endurance athletes revealed abnormal findings in more than 5 % of the athletes. However, the prognostic significance remains unclear. Thus, cardiac MRI cannot be recommended as a routine examination in the care of athletes.

Key points:

• CMR imaging helps clinicians to detect cardiovascular diseases in elite athletes.

• Differentiation between physiological adaptations and DCM/HCM can be a challenging task.

• Routine cardiac MRI examinations of endurance athletes cannot be recommended.

Citation Format:

• Mangold S, Kramer U, FranzenE et al. Detection of Cardiovascular Disease in Elite Athletes Using Cardiac Magnetic Resonance Imaging. Fortschr Röntgenstr 2013; 185: 1167 – 1174

Zusammenfassung

Ziel: In der Genese von plötzlichem Herztod bei Leistungssportlern spielen neben der hypertrophen und dilatativen Kardiomyopathie [HCM/DCM] auch die Myokarditis, Koronaranomalien und ischämische Herzerkrankungen eine wichtige Rolle. Zur Abklärung dieser potentiellen Risikofaktoren erfolgte die Durchführung einer kardialen Magnetresonanztomografie [MRT].

Material und Methoden: 73 männliche [M] und 22 weibliche [F] Athleten (Durchschnittsalter 35,2 ± 11,4 Jahre) wurden einer kardialen MRT zugeführt. EKG-getriggerte cine SSFP Sequenzen wurden verwendet um Wandbewegungsstörungen und Myokardhypertrophien zu diagnostizieren und um quantitative Auswertungen durchzuführen (links- und rechtsventrikuläres [LV, RV] enddiastolisches und endsystolisches Volumen [EDV, ESV], Schlagvolumen [SV], Ejektionsfraktion [EF] und die Myokardmasse [MM]). Zusätzlich wurden die Vorhofgrößen planimetrisch erfasst und Kontrastmittel injiziert, um fibrotische Veränderungen des Myokards nachzuweisen. Die Darstellung der Koronararterien erfolgte mittels einer Flash-3-D-MR-Angiografie.

Ergebnisse: Die quantitativen Analysen zeigten eine exzentrische LV-Hypertrophie (remodeling index [MM/LV-EDV]: männlich 0,75, weiblich 0,665), erhöhte RV-Volumina (RV-EDV: M 122,6 ± 19,0 ml/m², F 99,9 ± 7,2 ml/m²) sowie erhöhte SV (LV-SV: M 64,7 ± 10,0 ml/m², F 56,5 ± 5,7 ml/m²; RV-SV: M 66,7 ± 10,4 ml/m², F 54,2 ± 7,1 ml/m²). Pathologische Befunde fanden sich in 6 Athleten (6,3 %), darunter eine benigne Variante einer Koronaranomalie sowie fibrotische Myokardveränderungen in 2 Fällen. Wandbewegungsstörungen oder postischämische Veränderungen fanden sich hingegen nicht.

Schlussfolgerung: Die durchgeführte kardiale MRT in Leistungssportlern zeigte pathologische Befunde in über 5 % der Athleten, wobei die prognostische Relevanz solcher Befunde zunächst nicht abschließend zu beurteilen ist. Daher ist die routinemäßige Durchführung einer kardialen MRT in Leistungssportlern primär nicht zu empfehlen.

Kernaussagen:

• Die MRT liefert einen wichtigen Beitrag zur Diagnostik von kardiovaskulären Erkrankungen in Athleten.

• Die Differenzierung von physiologischen Anpassungsreaktionen und einer DCM/HCM stellt eine große Herausforderung dar.

• Eine routinemäßige Durchführung einer kardialen MRT in Leistungssportlern kann nicht empfohlen werden.

Key words

heart - cardiac - MR functional imaging - MR angiography - ischemia/infarction - normal variants

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