Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Poland.
Department of Pediatric Radiology, Medical University of Warsaw, Poland.
Eur J Radiol. 2019 Aug;117:89-94. doi: 10.1016/j.ejrad.2019.06.001. Epub 2019 Jun 3.
There is a direct reverse dose-effect relationship between the amount of physical activity and cardiovascular risk. It is unknown whether this is true for extreme, persistent endurance training. The aim of the study was to assess structural changes of the heart in long-time ultra-marathon runners with special focus on myocardial fibrosis using parametric mapping.
We studied a group of 30 healthy, male ultra-marathon runners (mean age 40.9 ± 6.6 yrs, median 9 yrs of running with frequent competitions) and 10 matched controls not engaged in any regular activities. All of them underwent cardiovascular magnetic resonance (CMR) with 3 T scanner including T1-mapping, late gadolinium enhancement (LGE) and extracellular volume (ECV) quantification.
Athletes demonstrated significantly larger heart chambers and left ventricular (LV) mass. LV systolic function was unchanged. 73.3% of athletes fulfilled volumetric criteria for dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy. Non-ischemic, small volume LGE was found in 8 athletes and in 1 control (27% vs. 10%, p = 0.40). It was localised at insertion points (5 athletes, 1 control) or in the septum or infero-lateral wall (3 athletes). Athletes with insertion point LGE had higher right ventricular end-diastolic volume index in comparison to athletes without LGE (p = 0.04), which suggests its relation to volume overload. There were no differences between athletes and non-athletes in terms of ECV values (26.1% vs. 25%, p = 0.29).
Ultra-marathon runner's hearts demonstrate a high degree of structural remodelling, but there is no significant increase in focal or diffuse myocardial fibrosis.
身体活动量与心血管风险之间存在直接的反向剂量效应关系。对于极端、持续的耐力训练是否如此，目前尚不清楚。本研究的目的是使用参数映射评估长期超长马拉松运动员的心脏结构变化，特别关注心肌纤维化。
我们研究了一组 30 名健康的男性超长马拉松运动员（平均年龄 40.9±6.6 岁，中位数 9 年跑步，经常参加比赛）和 10 名匹配的对照组（不参加任何常规活动）。所有受试者均在 3T 扫描仪上进行心血管磁共振（CMR）检查，包括 T1 映射、晚期钆增强（LGE）和细胞外容积（ECV）定量。
运动员的心脏腔室和左心室（LV）质量明显增大。LV 收缩功能无变化。73.3%的运动员符合扩张型心肌病或致心律失常性右室心肌病的容积标准。8 名运动员和 1 名对照组存在非缺血性、小体积 LGE（27%比 10%，p=0.40）。LGE 位于插入点（5 名运动员，1 名对照组）或间隔或下外侧壁（3 名运动员）。与无 LGE 的运动员相比，有插入点 LGE 的运动员右心室舒张末期容积指数更高（p=0.04），这表明其与容量超负荷有关。运动员和非运动员之间的 ECV 值无差异（26.1%比 25%，p=0.29）。
超长马拉松运动员的心脏表现出高度的结构重塑，但没有明显的局灶性或弥漫性心肌纤维化增加。
