Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, 04-635 Warsaw, Poland.
Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, 04-635 Warsaw, Poland.
Int J Environ Res Public Health. 2022 Apr 15;19(8):4829. doi: 10.3390/ijerph19084829.
Cardiac magnetic resonance (CMR) is a second-line imaging test in cardiology. Balanced enlargement of heart chambers called athlete's heart (AH) is a part of physiological adaptation to regular physical activity. The aim of this study was to evaluate the diagnostic utility of CMR in athletes with suspected structural heart disease (SHD) and to analyse the relation between the coexistence of AH and SHD. We wanted to assess whether the presence of AH phenotype could be considered as a sign of a healthy heart less prone to development of SHD. This retrospective, single centre study included 154 consecutive athletes (57 non-amateur, all sports categories, 87% male, mean age 34 ± 12 years) referred for CMR because of suspected SHD. The suspicion was based on existing guidelines including electrocardiographic and/or echocardiographic changes suggestive of abnormality but without a formal diagnosis. CMR permitted establishment of a new diagnosis in 66 patients (42%). The main diagnoses included myocardial fibrosis typical for prior myocarditis ( = 21), hypertrophic cardiomyopathy ( = 17, including 6 apical forms), other cardiomyopathies ( = 10) and prior myocardial infarction ( = 6). Athlete's heart was diagnosed in 59 athletes (38%). The presence of pathologic late gadolinium enhancement (LGE) was found in 41 patients (27%) and was not higher in athletes without AH (32% vs. 19%, = 0.08). Junction-point LGE was more prevalent in patients with AH phenotype (22% vs. 9%, = 0.02). Patients without AH were not more likely to be diagnosed with SHD than those with AH (49% vs. 32%, = 0.05). Based on the results of CMR and other tests, three patients (2%) were referred for ICD implantation for the primary prevention of sudden cardiac death with one patient experiencing adequate intervention during follow-up. The inclusion of CMR into the diagnostic process leads to a new diagnosis in many athletes with suspicion of SHD and equivocal routine tests. Athletes with AH pattern are equally likely to be diagnosed with SHD in comparison to those without AH phenotype. This shows that the development of AH and SHD can occur in parallel, which makes differential diagnosis in this group of patients more challenging.
心脏磁共振（CMR）是心脏病学中的二线影像学检查。心脏各腔室均衡增大，即运动员心脏（AH），是机体对规律运动的生理性适应的一部分。本研究旨在评估 CMR 在疑似结构性心脏病（SHD）运动员中的诊断效用，并分析 AH 与 SHD 共存的关系。我们希望评估 AH 表型的存在是否可以被认为是心脏更不易发生 SHD 的健康标志。这项回顾性、单中心研究纳入了 154 例连续就诊的运动员（57 例非职业运动员，涵盖所有运动项目，87%为男性，平均年龄 34 ± 12 岁），他们因疑似 SHD 而行 CMR 检查。疑似 SHD 的依据是现有的指南，包括心电图和/或超声心动图改变提示异常，但没有明确的诊断。CMR 可为 66 例（42%）患者建立新的诊断。主要诊断包括先前心肌炎的典型心肌纤维化（21 例）、肥厚型心肌病（17 例，包括 6 例心尖肥厚型）、其他心肌病（10 例）和先前心肌梗死（6 例）。59 例（38%）运动员诊断为 AH。41 例（27%）患者存在病理性延迟钆增强（LGE），而无 AH 的运动员中 LGE 并不更高（32%比 19%， = 0.08）。AH 表型患者的交界点 LGE 更为常见（22%比 9%， = 0.02）。无 AH 的患者与有 AH 的患者相比，更不可能被诊断为 SHD（49%比 32%， = 0.05）。基于 CMR 和其他检查的结果，3 例（2%）患者因 ICD 植入而被转诊，以预防有症状的 SCD，其中 1 例在随访期间接受了适当的干预。将 CMR 纳入诊断过程会为许多疑似 SHD 且常规检查结果不确定的运动员带来新的诊断。与无 AH 表型的患者相比，AH 模式的运动员更有可能被诊断为 SHD。这表明 AH 和 SHD 的发展可以同时发生，这使得这组患者的鉴别诊断更具挑战性。
