Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes
Open accessAbstract
There is still some controversy about the benignity of structural changes observed in athlete’s heart, especially regarding the observation of increased biomarkers and the presence of myocardial fibrosis (MF). Aim: Our purpose was to evaluate by cardiovascular magnetic resonance (CMR) the presence of diffuse as well as focal MF in a series of high-performance veteran endurance athletes. Methods: Thirty-four veteran healthy male endurance athletes, still being in regular training, with more than 10 years of training underwent a CMR. A cardiopulmonary exercise test was also performed to assess their maximal physical performance. The control group consisted in 12 non-trained normal individuals. Results: We found an increase in both, right and left ventricular (LV) volumes in the athlete’s group when compared with controls. There was no increase in indexed LV myocardial mass despite of a significantly increased maximal myocardial wall thickness in comparison to controls. Native T1 values and extracellular volume (ECV) were normal in all cases. We did not find differences in native T1 values and ECV between both groups. In three athletes (9%), non-ischaemic late gadolinium enhancement (LGE) was observed. We did not find a correlation between total training volume and presence of LGE or with the ECV value. Conclusions: Our results show that the majority of veteran endurance athletes present with myocardial remodelling without MF as a physiological adaptive phenomenon. In the only three athletes with focal MF, the LGE pattern observed suggests an intercurrent event not related with the remodelling phenomenon.
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The prevalence of myocardial fibrosis in VENTOUX was higher than previously reported, including studies that also excluded right ventricular insertion point late gadolinium enhancement from the definition of left ventricular fibrosis.
“The prevalence of myocardial fibrosis in VENTOUX (VENTricular arrhythmia and cardiac fibrOsis in endUrance eXperienced athletes) was higher than previously reported including those studies which also excluded RVIP LGE from the definition of LV fibrosis.10,11”
From Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX) (2025) · cites this paper as [10]
Myocardial fibrosis on late gadolinium enhancement imaging is a relatively common finding in older male endurance athletes.
“our data suggest that myocardial fibrosis on LGE imaging is a relatively common finding in older male endurance athletes.10”
From Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX) (2025) · cites this paper as [10]
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Cites
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Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX)
Javed, W., Botis, I., Goh, Z. M., Shabi, M., Brown, B., Tomoaia, R., Farooq, M., Levelt, E., Graham, L., Gierula, J., et al. (2025) · Circulation: Cardiovascular Imaging · doi:10.1161/circimaging.125.018470 · Cited by 21 · see citing works
“10 Although the mechanisms are as yet unclear, our findings suggest that certain athletes with this finding are at increased risk of ventricular arrhythmia and should undergo risk stratification for future arrhythmic risk.”
- Authors
- Pujadas, S., Doñate, M., Li, C.-H., Merchan, S., Cabanillas, A., Alomar, X., Pons-Llado, G., Serra-Grima, R., & Carreras, F.
- Affiliations
- Universitat Autònoma de Barcelona (ES)
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Radiology Department, Clínica Creu Blanca, Barcelona, Spain
- Corresponding author
- Pujadas, Sandra
- Venue
- BMJ Open Sport & Exercise Medicine
- Publisher
- BMJ
- Published
- 2018-10
- Volume
- 4
- Issue
- 1
- Pages
- e000422
- ISSN
- 2055-7647 (ISSN-L)
- PMC
- PMC6241997
- OpenAlex
- W2898235819
- Cited by
- 29
- References
- 2
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 4
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open Sport & Exercise Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- 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 › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- athlete's heart, myocardial remodelling, myocardial fibrosis, endurance athletes, older athletes, late gadolinium enhancement, extracellular volume, native T1 mapping, left ventricular wall thickness, left ventricular volume, cardiopulmonary exercise testing, training volume
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