CoChat
Sign Up
Cited by 2Cardiovascular Effects of ExerciseCardiomyopathy and Myosin StudiesCardiac electrophysiology and arrhythmias

Myocardial fibrosis and its relationship with ventricular arrhythmias and reduced ventricular systolic function in young and veteran endurance athletes

Open access
De Paepe, Jarne, D’Ambrosio, Paolo, De Bosscher, Ruben, Bekhuis, Youri, Pauwels, Rik, Dausin, Christophe, Janssens, Kristel, Mitchell, Amy +41 more·2026·European Journal of Preventive Cardiology
DOI 10.1093/eurjpc/zwaf715
Open this paper in CoChat — free account

Abstract

Aims: The prevalence of ventricular fibrosis and its association with ventricular arrhythmias (VAs) and reduced ventricular systolic function in endurance athletes remains unclear. Methods and results: We evaluated 296 young [median age 19 (17–22)] and 138 middle-aged [56 (50–60)] male endurance athletes, alongside 66 middle-aged non-athletic controls [54 (49–60)], all without known cardiac disease. Cardiac magnetic resonance imaging assessed myocardial fibrosis and biventricular function. Twenty-four-hour Holter monitoring was used to quantify VAs. Non-hinge-point fibrosis was more prevalent in middle-aged athletes compared with young athletes (20 vs. 3%, P < 0.001) and middle-aged controls (20 vs. 9%, P = 0.045), while hinge-point fibrosis did not differ. Reduced left ventricular ejection fraction and/or right ventricular ejection fraction was more frequent in middle-aged athletes than controls (23 vs. 8%, P = 0.009), but similar to young athletes (23 vs. 22%, P = 0.906). Middle-aged athletes had a higher prevalence of non-sustained ventricular tachycardia (8 vs. 2%, P = 0.006), >100 premature ventricular complexes/24 h (13 vs. 5%, P = 0.004), multifocal ventricular ectopy (11 vs. 4%, P = 0.003), and complex ventricular ectopy (25 vs. 10%, P < 0.001) compared with young athletes, with no significant differences compared with controls. Non-hinge-point fibrosis increased the odds of a higher burden of unifocal and multifocal ventricular ectopy, but not of reduced systolic function. Conclusion: Middle-aged athletes more frequently exhibit myocardial fibrosis than young athletes and middle-aged non-athletes. Non-hinge-point fibrosis is present in up to one-fifth of middle-aged athletes and predictive of a higher burden of both unifocal and multifocal ventricular ectopy. Reduced systolic function is more prevalent in athletes and not predicted by fibrosis. Lay summary: We studied young and middle-aged male endurance athletes and non-athletes using heart magnetic resonance imaging scans and 24 h heart rhythm monitoring to evaluate scarring of the heart muscle, pumping function, and abnormal heart rhythms.Scarring of the heart muscle is relatively common in middle-aged athletes, but rare in the young. About one in five middle-aged athletes showed a particular ‘non-hinge-point’ pattern of scar tissue, which was rare in young athletes and also less frequent in middle-aged non-athletic individuals.Non-hinge-point scar was linked with more frequent abnormal heart rhythms. Athletes with this pattern of scar more frequently had premature ventricular beats (extra beats originating from the heart’s lower chambers).

Integrity signals

Registry

Crossref · 10.1093/eurjpc/zwaf715

Cites

46 of 46 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Wasserman, 2011, Principles of Exercise Testing and Interpretation
  2. De Bosscher, 2022, Rationale and design of the PROspective ATHletic Heart (Pro@Heart) study: long-term assessment of the determinants of cardiac remodelling and its clinical consequences in endurance athletes, BMJ Open Sport Exerc Med, 8, e001309, 10.1136/bmjsem-2022-001309 · DOI

Cited by

Still being checked.

Authors
De Paepe, J., D’Ambrosio, P., De Bosscher, R., Bekhuis, Y., Pauwels, R., Dausin, C., Janssens, K., Mitchell, A., Elliott, A., Van De Heyning, C. M., Sanders, P., Kistler, P. M., Kalman, J. M., Fatkin, D., Heidbuchel, H., Herbots, L., Willems, R., Robyns, T., Ghekiere, O., Bogaert, J., La Gerche, A., Claessen, G., the Pro@Heart Consortium, Van Soest, S., Claus, P., Sinnaeve, P., Claeys, M., Goetschalckx, K., Van Puyvelde, T., Vandenberk, B., Hespel, P., Dymarkowski, S., Dresselaers, T., Delpire, B., Miljoen, H., Favere, K., Paelinck, B., Vermeulen, D., Witvrouwen, I., Hansen, D., Eijnde, B. O., Thijs, D., Vanvoorden, P., Lefebvre, K., Rowe, S., Spencer, L., Paratz, E., Brosnan, M. J., & Prior, D. L.
Affiliations
  • Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven B-3000 ,
  • The Royal Melbourne Hospital (AU)
  • Universitair Ziekenhuis Leuven (BE)
  • KU Leuven (BE)
  • UNSW Sydney (AU)
  • Heart, Exercise and Research Trials (HEART) lab, St Vincent’s Institute , Melbourne, VIC ,
  • Royal Adelaide Hospital (AU)
  • Department of Cardiovascular Sciences, University of Antwerp , Antwerpen ,
  • Baker Heart and Diabetes Institute (AU)
  • Victor Chang Cardiac Research Institute (AU)
  • Jessa Hospital (BE)
ORCID
Venue
European Journal of Preventive Cardiology
Publisher
Oxford University Press (OUP)
Published
2025-12-18
Volume
33
Issue
8
Pages
1405-1416
ISSN
  • 2047-4873 (ISSN-L)
  • 2047-4881
DOI
10.1093/eurjpc/zwaf715
OpenAlex
W4417477879
Semantic Scholar
dbd2946a1a805747a5f74780dac62a22dadbf2f0
Cited by
2
References
46
Citations by year
2026: 2
FWCI
1.30
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Preventive Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Document Server@UHasselt (UHasselt) (submittedVersion)
  • Lirias (submittedVersion, other-oa)
Funders
  • research foundation Flanders (T003717N)
  • National Health and Medical Research Council of Australia (APP1130353)
  • Abbott Belgium
  • Boston Scientific Belgium (1189325N)
  • Royal Australian College of Physicians Research Entry Scholarship (2023RES00039)
  • National Health and Medical Research Council Postgraduate Scholarship (2031119)
  • Heart Foundation PhD Scholarship (107659)
  • Australian Government Research Training Program Scholarship.
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
myocardial fibrosis, ventricular arrhythmias, endurance athletes, ventricular systolic function, reduced ejection fraction, non-sustained ventricular tachycardia, premature ventricular contractions, ventricular ectopy, athlete's heart, middle-aged athletes, youth athletes, cardiac magnetic resonance imaging, Holter monitoring
MeSH terms
Adolescent, Age Factors, Arrhythmias, Cardiac, Fibrosis, Humans, Male, Middle Aged, Cardiomyopathies, Myocardium, Physical Endurance, Risk Factors, Stroke Volume, Systole, Electrocardiography, Ambulatory, Prevalence, Case-Control Studies, Ventricular Function, Left, Ventricular Function, Right, Tachycardia, Ventricular, Ventricular Dysfunction, Left, Magnetic Resonance Imaging, Cine, Young Adult, Athletes

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review