Breuckmann Frank, Möhlenkamp Stefan, Nassenstein Kai, Lehmann Nils, Ladd Susanne, Schmermund Axel, Sievers Burkhard, Schlosser Thomas, Jöckel Karl-Heinz, Heusch Gerd, Erbel Raimund, Barkhausen Jörg
Department of Cardiology, West German Heart Center Essen, Essen, Germany.
Radiology. 2009 Apr;251(1):50-7. doi: 10.1148/radiol.2511081118.
To prospectively analyze the myocardial distribution of late gadolinium enhancement (LGE) with delayed-enhancement cardiac magnetic resonance (MR) imaging, to compare the prevalence of this distribution in nonprofessional male marathon runners with that in asymptomatic control subjects, and to examine the prognostic role of LGE.
Institutional review board and ethics committee approval were obtained for this study, and all subjects provided written informed consent. Two-dimensional inversion-recovery segmented k-space gradient-echo MR sequences were performed after administration of a gadolinium-containing contrast agent in 102 ostensibly healthy male runners aged 50-72 years who had completed at least five marathons during the past 3 years and in 102 age-matched control subjects. Predominantly subendocardial regions of LGE typical of myocardial infarction (hereafter, coronary artery disease [CAD] pattern) were distinguished from a predominantly midmyocardial patchy pattern of LGE (hereafter, non-CAD pattern). Marathon runners with LGE underwent repeat cardiac MR imaging and additional adenosine perfusion imaging. Runners were followed up for a mean of 21 months +/- 3 (standard deviation) after initial presentation. The chi(2), Fisher exact, and McNemar exact tests were used for comparisons. Event-free survival rates were estimated with the Kaplan-Meier method, and overall group differences were evaluated with log-rank statistics.
Of the 102 runners, five had a CAD pattern of LGE, and seven had a non-CAD pattern of LGE. The CAD pattern of LGE was located in the territory of the left anterior descending coronary artery more frequently than was the non-CAD pattern (P = .0027, Fisher exact test). The prevalence of LGE in runners was higher than that in age-matched control subjects (12% vs 4%; P = .077, McNemar exact test). The event-free survival rate was lower in runners with myocardial LGE than in those without myocardial LGE (P < .0001, log-rank test).
Ostensibly healthy marathon runners have an unexpectedly high rate of myocardial LGE, and this may have diagnostic and prognostic relevance.
前瞻性分析延迟强化心脏磁共振成像（MR）中晚期钆增强（LGE）的心肌分布，比较非职业男性马拉松运动员与无症状对照者中这种分布的患病率，并研究LGE的预后作用。
本研究获得机构审查委员会和伦理委员会批准，所有受试者均提供书面知情同意书。在102名年龄在50 - 72岁、在过去3年中至少完成过5次马拉松比赛的表面健康男性跑步者以及102名年龄匹配的对照者中，静脉注射含钆造影剂后进行二维反转恢复分段k空间梯度回波MR序列检查。将典型心肌梗死的主要心内膜下LGE区域（以下简称冠状动脉疾病[CAD]模式）与主要心肌中部斑片状LGE模式（以下简称非CAD模式）区分开来。有LGE的马拉松运动员接受重复心脏MR成像和额外的腺苷灌注成像。跑步者在初次就诊后平均随访21个月±3（标准差）。采用卡方检验、Fisher精确检验和McNemar精确检验进行比较。采用Kaplan-Meier方法估计无事件生存率，并用对数秩统计评估总体组间差异。
102名跑步者中，5人有CAD模式的LGE，7人有非CAD模式的LGE。CAD模式的LGE比非CAD模式更频繁地位于左前降支冠状动脉区域（P = 0.0027，Fisher精确检验）。跑步者中LGE的患病率高于年龄匹配的对照者（12%对4%；P = 0.077，McNemar精确检验）。有心肌LGE的跑步者的无事件生存率低于无心肌LGE的跑步者（P < 0.0001，对数秩检验）。
表面健康的马拉松运动员心肌LGE发生率意外地高，这可能具有诊断和预后意义。
