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Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease

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 su...

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Autores principales: Małek, Łukasz A., Miłosz-Wieczorek, Barbara, Marczak, Magdalena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031383/
https://www.ncbi.nlm.nih.gov/pubmed/35457693
http://dx.doi.org/10.3390/ijerph19084829
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author Małek, Łukasz A.
Miłosz-Wieczorek, Barbara
Marczak, Magdalena
author_facet Małek, Łukasz A.
Miłosz-Wieczorek, Barbara
Marczak, Magdalena
author_sort Małek, Łukasz A.
collection PubMed
description 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 (n = 21), hypertrophic cardiomyopathy (n = 17, including 6 apical forms), other cardiomyopathies (n = 10) and prior myocardial infarction (n = 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%, p = 0.08). Junction-point LGE was more prevalent in patients with AH phenotype (22% vs. 9%, p = 0.02). Patients without AH were not more likely to be diagnosed with SHD than those with AH (49% vs. 32%, p = 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.
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spelling pubmed-90313832022-04-23 Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease Małek, Łukasz A. Miłosz-Wieczorek, Barbara Marczak, Magdalena Int J Environ Res Public Health Article 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 (n = 21), hypertrophic cardiomyopathy (n = 17, including 6 apical forms), other cardiomyopathies (n = 10) and prior myocardial infarction (n = 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%, p = 0.08). Junction-point LGE was more prevalent in patients with AH phenotype (22% vs. 9%, p = 0.02). Patients without AH were not more likely to be diagnosed with SHD than those with AH (49% vs. 32%, p = 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. MDPI 2022-04-15 /pmc/articles/PMC9031383/ /pubmed/35457693 http://dx.doi.org/10.3390/ijerph19084829 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Małek, Łukasz A.
Miłosz-Wieczorek, Barbara
Marczak, Magdalena
Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease
title Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease
title_full Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease
title_fullStr Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease
title_full_unstemmed Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease
title_short Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease
title_sort diagnostic yield of cardiac magnetic resonance in athletes with and without features of the athlete’s heart and suspected structural heart disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031383/
https://www.ncbi.nlm.nih.gov/pubmed/35457693
http://dx.doi.org/10.3390/ijerph19084829
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