Structural myocardial disease or athlete’s heart? The diagnostic role of cardiac magnetic resonance (CMR) imaging in athletes with the suspicion of structural heart disease
█ Original article
Csécs Ibolya, Czimbalmos Csilla, Tóth Attila, Kiss Orsolya, Komka Zsolt, Bárczi György, Kováts Tímea, Suhai Ferenc Imre, Sydó Nóra, Simor Tamás1, Gellér László, Becker Dávid, Merkely Béla, Vágó Hajnalka
Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
1Pécsi Tudományegyetem, Klinikai Központ Szívgyógyászati Klinika, Pécs
According to literature data sudden cardiac death (SCD) is the most common cause of death in athletes occurring usually during intensive training. Our aim was to investigate the diagnostic role of cardiac magnetic resonance (CMR) in athletes with suspected structural myocardial diseases, to investigate the etiology of SCD, and to determine the frequency of the pathological conditions/diseases.
At the Heart and Vascular Center of the Semmelweis University during a 6-year period (2011–2016) we performed CMR scans on 153 athletes (112 males, age: 26.5±10.5 y) with suspected structural myocardial disease. Ten athletes were investigated after aborted SCD. We performed long- and short axis movies, measured the left and right ventricular ejection fractions, volumes and masses, and also investigated the wall motion abnormalities. T2-weighted images were performed for the detection of myocardial edema, and in 88% of the cases we investigated the necrosis/fibrosis on late gadolinium enhancement (LGE) images.
CMR confirmed the diagnosis of structural myocardial disease in 39 athletes (25.5%) (37 male, age: 27,2±17,0 y): hypertrophic cardiomyopathy (HCM) in 9 cases (23.0%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 7 cases (18.0%), noncompaction and dilated cardiomyopathy in 2-2 cases (5-5%). Subendocardial LGE, suggesting previous myocardial infarction, was found in 2 cases (5.0%), non-ischaemic LGE pattern in 15 cases (38.5%; patchy subepi-mid-myocardial LGE in 8 athletes, atypical LGE in 7 cases). One athlete was diagnosed with Fabry-disease (3.0%), one with coronary artery abnormality (3.0%). In aborted SCD cases CMR findings were the following: ARVC (n=3), atypical LGE pattern (n=2), and no structural myocardium abnormality (n=5).
In case of athletes CMR can have a key role in the identification of challenging disorders like apical HCM, ARVC, postmyocarditis. CMR can detect fibrosis even in the absence of wall motion and ECG abnormalities. The diagnosis, however, is not clear in some cases despite the thorough investigation. In our study the most common CMP was HCM, and in the SCD group ARVC was the leading CMP.