Allwood Richard P, Papadakis Michael, Androulakis Emmanuel
Sports Cardiology Department, Baker Heart and Diabetes Institute, Melbourne 3004, Australia.
Cardiovascular Clinical Academic Group, St George's, University of London, London SW17 0RE, UK.
J Clin Med. 2024 Aug 2;13(15):4536. doi: 10.3390/jcm13154536.
Exercise is associated with several cardiac adaptations that can enhance one's cardiac output and allow one to sustain a higher level of oxygen demand for prolonged periods. However, adverse cardiac remodelling, such as myocardial fibrosis, has been identified in athletes engaging in long-term endurance exercise. Cardiac magnetic resonance (CMR) imaging is considered the noninvasive gold standard for its detection and quantification. This review seeks to highlight factors that contribute to the development of myocardial fibrosis in athletes and provide insights into the assessment and interpretation of myocardial fibrosis in athletes. A literature search was performed using the PubMed/Medline database and Google Scholar for publications that assessed myocardial fibrosis in athletes using CMR. A total of 21 studies involving 1642 endurance athletes were included in the analysis, and myocardial fibrosis was found in 378 of 1595 athletes. A higher prevalence was seen in athletes with cardiac remodelling compared to control subjects (23.7 vs. 3.3%, < 0.001). Similarly, we found that young endurance athletes had a significantly higher prevalence than veteran athletes (27.7 vs. 19.9%, < 0.001), while male and female athletes were similar (19.7 vs. 16.4%, = 0.207). Major myocardial fibrosis (nonischaemic and ischaemic patterns) was predominately observed in veteran athletes, particularly in males and infrequently in young athletes. The right ventricular insertion point was the most common fibrosis location, occurring in the majority of female (96%) and young athletes (84%). Myocardial native T1 values were significantly lower in athletes at 1.5 T ( < 0.001) and 3 T ( = 0.004), although they had similar extracellular volume values to those of control groups. The development of myocardial fibrosis in athletes appears to be a multifactorial process, with genetics, hormones, the exercise dose, and an adverse cardiovascular risk profile playing key roles. Major myocardial fibrosis is not a benign finding and warrants a comprehensive evaluation and follow-up regarding potential cardiac disease.
运动与多种心脏适应性变化相关，这些变化可提高心输出量，并使人能够在较长时间内维持更高水平的氧气需求。然而，在长期进行耐力运动的运动员中，已发现不良心脏重塑，如心肌纤维化。心脏磁共振成像（CMR）被认为是其检测和量化的无创金标准。本综述旨在强调导致运动员心肌纤维化发展的因素，并深入探讨运动员心肌纤维化的评估和解读。使用PubMed/Medline数据库和谷歌学术进行文献检索，以查找使用CMR评估运动员心肌纤维化的出版物。分析共纳入21项研究，涉及1642名耐力运动员，在1595名运动员中有378名发现有心肌纤维化。与对照组相比，心脏重塑运动员的患病率更高（23.7%对3.3%，P<0.001）。同样，我们发现年轻耐力运动员的患病率明显高于资深运动员（27.7%对19.9%，P<0.001），而男女运动员患病率相似（19.7%对16.4%，P = 0.207）。主要心肌纤维化（非缺血性和缺血性模式）主要在资深运动员中观察到，尤其是男性，而在年轻运动员中很少见。右心室插入点是最常见的纤维化部位，大多数女性（96%）和年轻运动员（84%）中都有出现。尽管运动员的细胞外容积值与对照组相似，但在1.5T（P<0.001）和3T（P = 0.004）时，运动员的心肌固有T1值显著更低。运动员心肌纤维化的发展似乎是一个多因素过程，遗传、激素、运动剂量和不良心血管风险状况起着关键作用。主要心肌纤维化并非良性发现，需要对潜在心脏病进行全面评估和随访。
