Androulakis Emmanuel, Mouselimis Dimitrios, Tsarouchas Anastasios, Antonopoulos Alexios, Bakogiannis Constantinos, Papagkikas Panagiotis, Vlachopoulos Charalambos
Royal Brompton Hospital, Imaging Centre, Cardiac Magnetic Resonance Unit, London, United Kingdom.
Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Front Cardiovasc Med. 2021 Dec 21;8:784474. doi: 10.3389/fcvm.2021.784474. eCollection 2021.
Cardiac magnetic resonance (CMR) combined with late gadolinium enhancement (LGE) has revealed a non-negligible increased incidence of myocardial fibrosis (MF) in athletes compared to healthy sedentary controls. The aim of this systematic research and meta-analysis is to investigate and present our perspective regarding CMR indices in athletes compared to sedentary controls, including T1 values, myocardial extracellular volume (ECV) and positive LGE indicative of non-specific fibrosis, also to discuss the differences between young and veteran athletes. The protocol included searching, up to October 2021, of MEDLINE, EMBASE, SPORTDiscus, Web of Science and Cochrane databases for original studies assessing fibrosis via CMR in athletes. A mean age of 40 years differentiated studies' athletic populations to veteran and young. The research yielded 14 studies including in total 1,312 individuals. There was a statistically significant difference in LGE fibrosis between the 118/759 athletes and 16/553 controls ( = 5.2, < 0.001, = 0%, = 0.45). Notably, LGE fibrosis differed significantly between 546 (14.6%) veteran and 140 (25.7%) young athletes ( = 0.002). At 1.5T, T1 values differed between 117 athletes and 48 controls ( < 0.0001). A statistically significant difference was also shown at 3T (110 athletes vs. 41 controls, = 0.0004), as well as when pooling both 1.5T and 3T populations ( < 0.00001). Mean ECV showed no statistically significant difference between these groups. Based on currently available data, we reported that overall LGE based non-specific fibrosis and T1 values differ between athletes and sedentary controls, in contrast to ECV values. Age of athletes seems to have impact on the incidence of MF. Future prospective studies should focus on the investigation of the underlying pathophysiological mechanisms.
与健康的久坐不动的对照组相比，心脏磁共振成像（CMR）结合延迟钆增强（LGE）显示运动员心肌纤维化（MF）的发病率有不可忽视的增加。本系统研究和荟萃分析的目的是调查并阐述我们对于运动员与久坐对照组相比的CMR指标的观点，包括T1值、心肌细胞外容积（ECV）以及提示非特异性纤维化的LGE阳性情况，同时讨论年轻运动员和资深运动员之间的差异。该方案包括截至2021年10月，在MEDLINE、EMBASE、SPORTDiscus、科学网和Cochrane数据库中检索通过CMR评估运动员纤维化的原始研究。平均年龄40岁将研究中的运动员群体分为资深运动员和年轻运动员。该研究产生了14项研究，共纳入1312名个体。118/759名运动员和16/553名对照组之间的LGE纤维化存在统计学显著差异（χ² = 5.2，P < 0.001，OR = 0%，RR = 0.45）。值得注意的是，546名（14.6%）资深运动员和140名（25.7%）年轻运动员之间的LGE纤维化存在显著差异（P = 0.002）。在1.5T时，117名运动员和48名对照组之间的T1值存在差异（P < 0.0001）。在3T时（110名运动员对41名对照组，P = 0.0004）以及合并1.5T和3T人群时（P < 0.00001）也显示出统计学显著差异。平均ECV在这些组之间未显示出统计学显著差异。基于目前可用的数据，我们报告称，与ECV值相比，基于LGE的总体非特异性纤维化和T1值在运动员和久坐对照组之间存在差异。运动员的年龄似乎对MF的发病率有影响。未来的前瞻性研究应侧重于潜在病理生理机制的研究。
