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Cited by 21Cardiovascular Effects of ExerciseCardiomyopathy and Myosin StudiesCardiac electrophysiology and arrhythmias

Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX)

Open access
Javed, Wasim, Botis, Ioannis, Goh, Ze Min, Shabi, Mubien, Brown, Benjamin, Tomoaia, Raluca, Farooq, Maryum, Levelt, Eylem +6 more·2025·Circulation: Cardiovascular Imaging
DOI 10.1161/circimaging.125.018470PMC PMC12356567
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Abstract

BACKGROUND: Sudden cardiac death due to primary arrhythmia is a leading cause of mortality in athletes, predominantly affecting older male athletes. Myocardial fibrosis is strongly associated with arrhythmogenesis in nonischemic cardiomyopathy, but its clinical significance in asymptomatic endurance athletes is unknown. We aimed to investigate whether myocardial fibrosis on cardiovascular magnetic resonance in asymptomatic veteran male athletes was associated with incident ventricular arrhythmia on long-term implantable loop recorder. METHODS: Prospective observational cohort study involving 106 asymptomatic male competitive cyclists/triathletes (aged ≥50 years) who undertook ≥10 h/wk of exercise for ≥15 years. Exclusion criteria were any preexisting cardiovascular disease. Participants underwent clinical assessment, stress-perfusion late gadolinium enhancement-cardiovascular magnetic resonance, exercise testing, and implantable loop recorder implantation to detect ventricular arrhythmia. Athletes were followed up for the primary end point of incident ventricular arrhythmia. RESULTS: A total of 50/106 (47.2%) athletes had focal myocardial fibrosis (all nonischemic distribution) on cardiovascular magnetic resonance predominantly affecting the basal inferolateral left ventricular segment. During follow-up (median 720 days), 23/106 (21.7%) athletes experienced ≥1 ventricular arrhythmic episode; 3/106 (2.8%) sustained ventricular tachycardia, and 20/106 (18.9%) nonsustained ventricular tachycardia. Myocardial fibrosis (hazard ratio, 4.7 [95% CI, 1.8–12.8]; P =0.002) and greater left ventricular end-diastolic volume indexed (hazard ratio, 1.4 [95% CI, 1.1–1.9]; P =0.02) were associated with an increased risk of incident ventricular arrhythmia, but right ventricular insertion point late gadolinium enhancement was not (hazard ratio, 1.7 [95% CI 0.6–5.1]; P =0.32). Myocardial fibrosis remained predictive after adjusting for left ventricular end-diastolic volume indexed (hazard ratio, 4.7 [95% CI, 1.7–12.7]; P =0.002). CONCLUSIONS: In male veteran endurance athletes, myocardial fibrosis was independently associated with the onset of ventricular arrhythmia, even after adjusting for left ventricular dilatation. Right ventricular insertion point late gadolinium enhancement was not associated with ventricular arrhythmia. Further studies are needed to establish whether myocardial fibrosis itself is arrhythmogenic or a marker of an underlying cardiomyopathic process.

AI snapshot

Written from the paper’s full text.

TL;DR

In asymptomatic veteran male endurance athletes, nonischemic myocardial fibrosis on CMR was common and independently associated with incident ventricular arrhythmia on implantable loop recorder monitoring. Right ventricular insertion point LGE was not associated with ventricular arrhythmia, and the study cannot determine whether fibrosis is itself arrhythmogenic or a marker of concealed cardiomyopathy.

Key findings

  • Focal myocardial fibrosis was present in 50/106 athletes (47.2%), all nonischemic, predominantly basal inferolateral LV in 44/50 (88.0%); prevalence was higher than in age-matched nonathletes (50/106 [47.2%] versus 3/27 [11.1%], P<0.001).
  • Over median 720 days, 23/106 (21.7%) had ≥1 ventricular arrhythmic episode: 3/106 (2.8%) sustained VT and 20/106 (18.9%) nonsustained VT; 18/23 (78.3%) with ventricular arrhythmia had fibrosis versus 5/23 (21.7%) without (P<0.001), and all 3 with sustained VT had fibrosis.
  • Myocardial fibrosis was associated with incident ventricular arrhythmia (HR, 4.7 [95% CI, 1.8–12.8]; P=0.002), as were LVEDVi (HR, 1.41 per 10 mL/m² increase [95% CI, 1.05–1.88]; P=0.02) and exercise-induced PVCs (HR, 3.9 [95% CI, 1.32–11.4]; P=0.01); RVIP LGE was not (HR, 1.7 [95% CI, 0.6–5.1]; P=0.32).
  • After adjustment for LVEDVi, fibrosis remained predictive (HR, 4.7 [95% CI, 1.7–12.7]; P=0.002), as did LVEDVi (HR, 1.04 [95% CI, 1.01–1.07]; P=0.02).

Methods

  • Prospective observational single-center cohort of 106 asymptomatic male competitive cyclists/triathletes aged ≥50 years undertaking ≥10 h/wk exercise for ≥15 years, without preexisting cardiovascular disease; 139 were screened, with exclusions for age (n=6) and prior CVD (n=27). A comparative group of 27 age-matched male nonathletic controls underwent identical CMR.
  • Participants underwent clinical assessment, 3.0T CMR with cine, adenosine stress/rest perfusion, T1/T2 mapping, and late gadolinium enhancement; exercise testing; and Biomonitor IIIm implantable loop recorder implantation. Primary end point was incident ventricular arrhythmia, with VT defined as ≥30 seconds at >100 bpm and nonsustained VT as ≥3 consecutive ventricular beats lasting ≤30 seconds, adjudicated by a consultant electrophysiologist blinded to CMR findings.
  • Analysis used Cox proportional hazards regression, Kaplan-Meier/log-rank testing, and a prespecified multivariable model including 1 covariate per 10 outcome events; SPSS Statistics 29 was used, with 2-sided P<0.05 considered significant.

Limitations

  • The paper states the main limitations are limited sample size and highly selected participants, so findings may not generalize to women or nonwhite athletes; the high training requirement means the results do not support CMR screening of unselected athletes.
  • The paper also states recruitment was via self-referral with self-reported training history, raising possible referral bias; athletes did not undergo genetic testing; single-lead ILRs could not localize ventricular arrhythmia to the fibrosis site; and the ventricular arrhythmia end point only indirectly correlates with sudden cardiac death.
  • Evident from the text: the study was observational and not powered to detect SCD, and the nonathletic control group underwent CMR only, so it provided fibrosis prevalence data but no arrhythmia follow-up comparison.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1161/circimaging.125.018470

Cites

17 of 17 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

8 of 10 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The same group investigated athletes presenting with exercise-induced ventricular arrhythmia and demonstrated that this pattern of myocardial fibrosis was associated with a 7-fold increased risk of recurrent ventricular arrhythmia during exercise testing.

    “The same group investigated athletes presenting with exercise-induced ventricular arrhythmia and demonstrated this pattern of myocardial fibrosis was associated with a 7-fold increased risk of recurrent ventricular arrhythmia during exercise testing.9”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] Brunetti G Graziano F Cavigli L Cipriani A D’Ascenzi F Bauce B Pilichou K Perazzolo Marra M Corrado D Zorzi A. Reproducibility of ventricular arrhythmias at exercise testing for prediction of non-ischaemic left ventricular scar in athletes. Eur J Prev Cardiol. 2022; 30: 107– 116. doi: 10.1093/eurjpc/zwac224 36166397 source
  • Premisecitation

    Zorzi et al found that athletes who presented with ventricular arrhythmia and were subsequently found to have nonischemic lateral left ventricular wall fibrosis on cardiovascular magnetic resonance were more likely to experience malignant arrhythmic events than those without fibrosis.

    “Zorzi et al8 found athletes who presented with ventricular arrhythmia and were subsequently found to have nonischemic lateral LV wall fibrosis on CMR were more likely to experience malignant arrhythmic events than those without fibrosis.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Zorzi A Marra MP Rigato I Lazzari MD Susana A Niero A Pilichou K Migliore F Rizzo S Giorgi B. Nonischemic left ventricular scar as a substrate of life-threatening ventricular arrhythmias and sudden cardiac death in competitive athletes. Circ Arrhythm Electrophysiol. 2016; 9: e004229. doi: 10.1161/CIRCEP.116.004229 27390211 PMC4956679 source
  • Findingown data

    Exercise-induced hypertension was not independently associated with myocardial fibrosis in VENTOUX.

    “Tahir et al4 found exercise-induced hypertension was independently associated with myocardial fibrosis in triathletes; however, this was not replicated in VENTricular arrhythmia and cardiac fibrOsis in endUrance eXperienced athletes.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [4] Tahir E Starekova J Muellerleile K von Stritzky A Munch J Avanesov M Weinrich JM Stehning C Bohnen S Radunski UK. Myocardial fibrosis in competitive triathletes detected by contrast-enhanced CMR correlates with exercise-induced hypertension and competition history. JACC Cardiovasc Imaging. 2018; 11: 1260– 1270. doi: 10.1016/j.jcmg.2017.09.016 29248656 source
  • Interpretationcitation

    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”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [10] Pujadas S Doñate M Li CH Merchan S Cabanillas A Alomar X Pons-Llado G Serra-Grima R Carreras F. Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes. BMJ Open Sport Exerc Med. 2018; 4: e000422. doi: 10.1136/bmjsem-2018-000422 PMC6241997 30498573 source
    • cites [11] Merghani A Maestrini V Rosmini S Cox AT Dhutia H Bastiaenan R David S Yeo TJ Narain R Malhotra A. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation. 2017; 136: 126– 137. doi: 10.1161/CIRCULATIONAHA.116.026964 28465287 source
  • Interpretationown data

    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”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [10] Pujadas S Doñate M Li CH Merchan S Cabanillas A Alomar X Pons-Llado G Serra-Grima R Carreras F. Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes. BMJ Open Sport Exerc Med. 2018; 4: e000422. doi: 10.1136/bmjsem-2018-000422 PMC6241997 30498573 source
  • Classified as probably not a substantial claim. 10
  • May combine two claims. 19

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The annual incidence of sudden cardiac death during sport is reported to be up to 6.8 per 100,000 athletes in certain cohorts.

    “Although the annual incidence of SCD during sport varies between studies, it is reported to be up to 6.8 per 100 000 athletes in certain cohorts.15”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Finocchiaro G Westaby J Sheppard MN Papadakis M Sharma S. Sudden cardiac death in young athletes: JACC state-of-the-art review. J Am Coll Cardiol. 2024; 83: 350– 370. doi: 10.1016/j.jacc.2023.10.032 38199713 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Male athletes are over seven times more likely to suffer sudden cardiac death than female athletes.

    “We also only recruited male athletes, who are over seven times more likely to suffer SCD than female athletes.17”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] Landry CH Allan KS Connelly KA Cunningham K Morrison LJ Dorian P; Rescu Investigators. Sudden cardiac arrest during participation in competitive sports. N Engl J Med. 2017; 377: 1943– 1953. doi: 10.1056/NEJMoa1615710 29141175 PMC5726886 source

      The Results report an overall sudden cardiac arrest incidence among competitive athletes, and the Discussion distinguishes cardiac arrest from cardiac death. Neither section gives a male-to-female risk comparison; searches for male, female, and a sevenfold difference found no passage supporting the claimed ratio. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ventricular arrhythmia is believed to be the main mechanism of sudden cardiac death in athletes.

    “Ventricular arrhythmia is believed to be the main mechanism of SCD in athletes.3”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [3] Finocchiaro G Papadakis M Robertus JL Dhutia H Steriotis AK Tome M Mellor G Merghani A Malhotra A Behr E. Etiology of sudden death in sports: insights from a United Kingdom regional registry. J Am Coll Cardiol. 2016; 67: 2108– 2115. doi: 10.1016/j.jacc.2016.02.062 27151341 source

      The Causes section reports sudden arrhythmic death syndrome as the most common finding, accounting for 42% of athlete deaths. But the Study Population section defines that syndrome by a normal post-mortem examination, not a documented rhythm; the paper does not establish that ventricular arrhythmia is the main mechanism of SCD in athletes. (LLM, conf=0.79)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Indices of quantitative stress perfusion did not differ between athletes with and without myocardial fibrosis, and there was no evidence of inducible perfusion defects in any athlete.

    “Indices of quantitative stress perfusion did not differ between athletes with and without myocardial fibrosis, and there was no evidence of inducible perfusion defects in any athlete (stress myocardial blood flow 2.2±0.7 mL/g per minute versus 2.2±0.7 mL/g per minute, P=0.85; rest myocardial blood flow 0.6 mL/g per minute ±0.2 versus 0.6 mL/g per minute ±0.2, P=0.23; myocardial perfusion reserve 3”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Athletes with ventricular arrhythmia had significantly greater left ventricular end-diastolic volume indexed (113±18 mL/m2 versus 106±13 mL/m2, P=0.04) and native T1 times (1252±46 ms versus 1241±39 ms, P=0.03) than those without ventricular arrhythmia.

    “Athletes with ventricular arrhythmia on ILR monitoring also exhibited significantly greater LVEDVi (113±18 mL/m2 versus 106±13 mL/m2; P=0.04) and native T1 times (1252±46 ms versus 1241±39 ms; P=0.03) than those without ventricular arrhythmia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All athletes in the study were asymptomatic at recruitment without known prior arrhythmia, were actively competing, and achieved above-average age-adjusted estimated VO2max on exercise testing.

    “However, all athletes in our study were asymptomatic at recruitment without known prior arrhythmia, were actively competing, and achieved above-average age-adjusted estimated VO2max on exercise testing.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There were no significant differences in left ventricular ejection fraction, right ventricular size, or right ventricular function between athletes with and without ventricular arrhythmia.

    “There were no significant differences in LV ejection fraction (55.8±4.2% versus 55.9±4.2%; P=0.92), RV size or right ventricular function between the groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were no significant differences in any cardiovascular magnetic resonance parameter between athletes with and without fibrosis, including left ventricular end-diastolic volume indexed and left ventricular ejection fraction.

    “There were no significant differences in any CMR parameter between those with and without fibrosis including LV end-diastolic volume indexed (LVEDVi) to BSA (110±15 mL/m2 versus 106±14 mL/m2; P=0.23) and LV ejection fraction (55.8±4.1% versus 56.0±4.3%; P=0.86), while CMR findings of balanced biventricular dilatation were in keeping with athletic remodeling among both groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    12/106 (11.3%) athletes experienced recurrent ventricular arrhythmia (≥2 episodes of nonsustained ventricular tachycardia/ventricular tachycardia), of whom 11/12 (91.7%) had myocardial fibrosis.

    “12/106 (11.3%) athletes also experienced recurrent ventricular arrhythmia (≥2 episodes of nonsustained VT/VT) of whom 11/12 (91.7%) had myocardial fibrosis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There were no significant differences in any baseline characteristics or training history characteristics between athletes with and without ventricular arrhythmia.

    “Furthermore, there were no significant differences in any baseline characteristics or training history characteristics in athletes with and without ventricular arrhythmia (Table S4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No athlete had a T2 value >50 ms, and no athlete fulfilled Lake Louise Criteria for acute myocarditis.

    “No athlete had a T2 value >50 ms which would be indicative of acute myocardial edema, and no athlete fulfilled Lake Louise Criteria for acute myocarditis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the athletes, 3/106 (2.8%) had sustained ventricular tachycardia and 20/106 (18.9%) had nonsustained ventricular tachycardia.

    “3/106 (2.8%) sustained ventricular tachycardia, and 20/106 (18.9%) nonsustained ventricular tachycardia.”
    • Also stated in: § Incidence of Ventricular Arrhythmia · plain
      “with 3/106 (2.8%) having VT and 20/106 (18.9%) having nonsustained VT”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Asymptomatic ventricular arrhythmia is associated with increased mortality in the general population.

    “however asymptomatic ventricular arrhythmia is associated with increased mortality in the general population.16”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Bikkina M Larson MG Levy D. Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study. Ann Intern Med. 1992; 117: 990– 996. doi: 10.7326/0003-4819-117-12-990 1280018 source

  • May combine two claims.

    Interpretationown data

    Myocardial fibrosis on cardiovascular magnetic resonance, left ventricular dilatation, and premature ventricular contractions during exercise are independent predictors of future ventricular arrhythmia.

    “VENTricular arrhythmia and cardiac fibrOsis in endUrance eXperienced athletes adds to this literature by prospectively demonstrating that myocardial fibrosis on CMR, LV dilatation, and PVCs during exercise are independent predictors of future ventricular arrhythmia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    T1 values in both athlete groups were well within the normal range and therefore unlikely to represent an underlying cardiomyopathy.

    “While athletes with ventricular arrhythmia had significantly higher native T1 values than athletes without ventricular arrhythmia, T1 values in both athlete groups were well within the normal range and therefore unlikely to represent an underlying cardiomyopathy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Right ventricular insertion point late gadolinium enhancement is likely a benign finding in athletes which may be related to physiological enlargement of the right ventricle.

    “This supports the argument that RVIP is likely to be a benign finding in athletes which may be related to physiological enlargement of the right ventricular.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    The end point of ventricular arrhythmia only indirectly correlates with sudden cardiac death.

    “Finally, the end point of ventricular arrhythmia only indirectly correlates with SCD, and therefore, the clinical implications of our findings require further study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Arrhythmic events were confirmed by a Consultant Electrophysiologist blinded to cardiovascular magnetic resonance findings.

    “Arrhythmic events were confirmed by a Consultant Electrophysiologist blinded to CMR findings.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Power calculations were performed to determine the study sample size, which was deemed sufficient to enable a univariate Cox regression model to be fitted on time to ventricular arrhythmia, adjusting for the presence of fibrosis with a 5% participant dropout margin.

    “Power calculations were performed to determine the study sample size, which was deemed sufficient to enable a univariate Cox regression model to be fitted on time to ventricular arrhythmia, adjusting for the presence of fibrosis with a 5% participant dropout margin.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A prespecified statistical analysis plan was produced before study commencement by a statistician.

    “A prespecified statistical analysis plan was produced before study commencement by a statistician (Leeds Clinical Trials Research Unit).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The main limitation of the study is the limited sample size and highly selected nature of participants, and it remains to be established whether the findings in older, male, white European cyclists and triathletes would be replicated in other groups, including women and nonwhite athletes.

    “The main limitation of our study is the limited sample size and highly selected nature of participants, and it remains to be established whether our findings in older, male, white European cyclists and triathletes would be replicated in other groups, including women and nonwhite athletes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The higher prevalence of myocardial fibrosis in VENTOUX may be explained by the study only including older male athletes, with age being the variable most significantly associated with myocardial fibrosis.

    “This may be explained by our study only including older male athletes (age was the variable most significantly associated with myocardial fibrosis).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Athletes were recruited via self-referral using self-reported training history, and it is possible that recruited athletes already harbored health concerns, leading to a referral bias.

    “Athletes were recruited via self-referral using self-reported training history. While they denied symptoms and were screened for baseline CVD, it is possible that recruited athletes already harbored health concerns, thus leading to a referral bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The annual rate of any ventricular arrhythmia in this study (10.9%) or sustained ventricular tachycardia (1.4%) is considerably higher than sudden cardiac death rates from the general population.

    “The annual rate of any ventricular arrhythmia in our study (10.9%) or sustained VT (1.4%) is considerably higher than SCD rates from the general population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A multivariable model was prespecified to include 1 covariate per 10 outcome events.

    “A multivariable model was also prespecified to include 1 covariate per 10 outcome events.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The association between fibrosis and recurrent ventricular arrhythmia was even stronger than for incident ventricular arrhythmia, with fibrosis found in 11/12 of such athletes.

    “The association between fibrosis and recurrent ventricular arrhythmia was even stronger, with fibrosis found in 11/12 of such athletes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Athletes did not undergo genetic testing, which may have identified concealed cardiomyopathy.

    “Furthermore, athletes did not undergo genetic testing, which may have identified concealed cardiomyopathy.”
    Quote in the paperNot a substantial claim
27 of 27

  • The paper relies on this without support.

    Cardiovascular magnetic resonance imaging can detect and quantify left ventricular fibrosis in vivo with high accuracy.

    “Cardiovascular magnetic resonance (CMR) imaging can detect and quantify LV fibrosis in vivo with high accuracy.”

  • The paper relies on this without support.

    Veteran male endurance athletes are the group most likely to exhibit myocardial fibrosis on cardiovascular magnetic resonance and to have the highest risk of sudden cardiac death during sport.

    “Veteran male endurance athletes were specifically chosen as previous data identifies this group as those most likely to exhibit myocardial fibrosis on CMR and have the highest risk of SCD during sport.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • LV cavity risk increase is stated with the wrong denominator

    Minor

    The reported hazard ratio is for a 10 mL/m2 increase in indexed LV end-diastolic volume, but the discussion describes it as a 10 mL increase in cavity size.

1 of 1

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Authors
Javed, W., Botis, I., Goh, Z. M., Shabi, M., Brown, B., Tomoaia, R., Farooq, M., Levelt, E., Graham, L., Gierula, J., Kellman, P., Greenwood, J. P., Plein, S., & Swoboda, P. P.
Affiliations
  • National Health Service (GB)
  • Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds/Leeds Teaching Hospitals National Health Service Trust, United Kingdom (W.J., I.B., Z.M.G., M.S., B.B., R.T., M.F., L.G., J.G., J.P.G., S.P., P.P.S.).
  • Baker Heart and Diabetes Institute (AU)
  • National Institutes of Health (US)
ORCID
Venue
Circulation: Cardiovascular Imaging
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2025-08
Volume
18
Issue
8
Pages
e018470-e018470
ISSN
  • 1941-9651 (ISSN-L)
  • 1942-0080
DOI
10.1161/circimaging.125.018470
PMC
PMC12356567
OpenAlex
W4412493452
Semantic Scholar
aa5ed2c7cb2f7066b0be5498a26662956b77fd22
Cited by
21
References
17
Citations by year
2026: 15 · 2025: 6
FWCI
13.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Circulation Cardiovascular Imaging (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
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, endurance athletes, sudden cardiac death, late gadolinium enhancement, cardiovascular magnetic resonance, implantable loop recorder, non-ischemic cardiomyopathy, left ventricular end-diastolic volume, sustained ventricular tachycardia, non-sustained ventricular tachycardia, competitive cyclists, triathletes
MeSH terms
Aged, Arrhythmias, Cardiac, Exercise Test, Fibrosis, Humans, Male, Middle Aged, Cardiomyopathies, Myocardium, Physical Endurance, Prospective Studies, Risk Factors, Time Factors, Electrocardiography, Ambulatory, Incidence, Death, Sudden, Cardiac, Tachycardia, Ventricular, Magnetic Resonance Imaging, Cine, Athletes

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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.

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