Cardiac remodeling in university athletes: non-contrast magnetic resonance imaging study

Abstract

Early detection of exercise-induced cardiac anomalies is a key to clinical management for individuals engaged in vigorous exercise training. This study aimed to investigate cardiovascular adaptation in university students engaged in intensive exercises using cardiac magnetic resonance imaging. For this prospective, single-center study, 50 university students who finished a four-year intensively endurance training and 23 age- and gender- matched controls received cardiac magnetic resonance imaging. Exercised participants were further divided into symptomatic and asymptomatic groups. Left ventricular volumes and volumes indexed to the body surface were calculated. Global peak strains and systolic and diastolic peak strain rates were derived from cine images using a feature tracking technique. Analysis of variance analyses were performed. Fifty exercised participants (mean age: 21±1 y; 43 males, including 21 symptomatic and 29 asymptomatic cases) and 23 normal controls (mean age: 21±2 y, 20 males) were evaluated. Exercised participants exhibited a higher end-diastolic left ventricular volume (76.0±10.6 ml vs. 63.5±7.5 ml, p<0.001), a reduced left ventricular ejection fraction (59.9%±5.3 vs. 63.0%±3.2, p=0.002) and a reduced global longitudinal strain (−18.25±3.32 vs.−19.85±1.29, p=0.004) than the normal control participants. Symptomatic excised participants showed reduced peak strains compared to both asymptomatic participants and normal controls. Only a circumferential diastolic peak strain rate was reduced when compared between asymptomatic cases and controls. In conclusions, highly intensive exercises could result in elevated left ventricular volumes and reduced myocardial strains for young university students. Furthermore, reduced myocardial strains were found for those symptomatic cases which remain within non-pathological ranges.

Keywords

cardiac magnetic resonance - left ventricular remodeling - myocardial strain - strain rate - exercise Training

Publication History

Received: 07 June 2024

Accepted after revision: 20 March 2025

Accepted Manuscript online:
20 March 2025

Article published online:
11 April 2025

• References

• 1 Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J 2015; 36: 1445-1453
• 2 Pelliccia A, Caselli S, Sharma S. et al. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart. Eur Heart J 2018; 39: 1949-1969
• 3 Oxborough D, McDerment D, George KP. et al. Allometric scaling for left ventricular mass and geometry in male and female athletes of mixed and endurance sports. Echo Res Pract 2024; 11: 4
• 4 Park JH, Oh JK, Kim KH. et al. Left Ventricular Longitudinal Strain and Strain Rate Values According to Sex and Classifications of Sports in the Young University Athletes Who Participated in the 2015 Gwangju Summer Universiade. JACC Cardiovasc Imaging 2018; 11: 1719-1721
• 5 McHugh C, Hind K, Davey D, Wilson F. Cardiovascular Health of Retired Field-Based Athletes: A Systematic Review and Meta-analysis. Orthopaedic J Sports Med 2019; 7: 2325967119862750
• 6 Levine BD. Can intensive exercise harm the heart? The benefits of competitive endurance training for cardiovascular structure and function. Circulation 2014; 130: 987-991
• 7 Humbert M, Kovacs G, Hoeper MM. et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respi J 2023; 61: 2200879
• 8 Czimbalmos C, Csecs I, Dohy Z. et al. Cardiac magnetic resonance based deformation imaging: role of feature tracking in athletes with suspected arrhythmogenic right ventricular cardiomyopathy. Int J Cardiovasc Imaging 2019; 35: 529-538
• 9 Gastl M, Lachmann V, Christidi A. et al. Cardiac magnetic resonance T2 mapping and feature tracking in athlete’s heart and HCM. Eur Radiol 2021; 31: 2768-2777
• 10 Gao H, Wang Z, Yang F. et al. Graphene-integrated mesh electronics with converged multifunctionality for tracking multimodal excitation-contraction dynamics in cardiac microtissues. Nat Commun 2024; 15: 2321
• 11 Wilk M, Zajac A, Tufano JJ. The Influence of Movement Tempo During Resistance Training on Muscular Strength and Hypertrophy Responses: A Review. Sports Med (Auckland, NZ) 2021; 51: 1629-1650
• 12 Grigoratos C, Aimo A, Barison A. et al. Cardiac magnetic resonance in patients with muscular dystrophies. Eur J Prev Cardiol 2021; 28: 1526-1535
• 13 Hannukainen JC, Lautamäki R, Mari A. et al. Elevated Glucose Oxidation, Reduced Insulin Secretion, and a Fatty Heart May Be Protective Adaptions in Ischemic CAD. J Clin Endocrinol Metab 2016; 101: 2701-2710
• 14 Zhao X, Teo SK, Zhong L. et al. Reference Ranges for Left Ventricular Curvedness and Curvedness-Based Functional Indices Using Cardiovascular Magnetic Resonance in Healthy Asian Subjects. Sci Rep 2020; 10: 8465
• 15 Caselli S, Di Paolo FM, Pisicchio C. et al. Three-dimensional echocardiographic characterization of left ventricular remodeling in Olympic athletes. Am J Cardiol 2011; 108: 141-147
• 16 Heidbuchel H. The athlete’s heart is a proarrhythmic heart, and what that means for clinical decision making. Europace 2018; 20: 1401-1411
• 17 La Gerche A, Wasfy MM, Brosnan MJ. et al. The Athlete’s Heart-Challenges and Controversies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 80: 1346-1362
• 18 Kübler J, Burgstahler C, Brendel JM. et al. Cardiac MRI findings to differentiate athlete’s heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy. Int J Cardiovasc Imaging 2021; 37: 2501-2515
• 19 Claessen G, De Bosscher R, Janssens K. et al. Reduced Ejection Fraction in Elite Endurance Athletes: Clinical and Genetic Overlap With Dilated Cardiomyopathy. Circulation 2024; 149: 1405-1415
• 20 Galderisi M, Cardim N, D’Andrea A. et al. The multi-modality cardiac imaging approach to the Athlete’s heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 353
• 21 Luijkx T, Cramer MJ, Prakken NH. et al. Sport category is an important determinant of cardiac adaptation: an MRI study. Br J Sports Med 2012; 46: 1119-1124
• 22 McNamara DA, Aiad N, Howden E. et al. Left Atrial Electromechanical Remodeling Following 2 Years of High-Intensity Exercise Training in Sedentary Middle-Aged Adults. Circulation 2019; 139: 1507-1516
• 23 Cho JY, Kim KH, Rink L. et al. University athletes and changes in cardiac geometry: insight from the 2015 Gwangju Summer Universiade. Eur Heart J Cardiovasc Imaging 2019; 20: 407-416
• 24 Małek ŁA, Mazurkiewicz Ł, Marszałek M. et al. Deformation Parameters of the Heart in Endurance Athletes and in Patients with Dilated Cardiomyopathy-A Cardiac Magnetic Resonance Study. Diagnostics (Basel, Switz) 2021; 11: 374
• 25 Parry-Williams G, Gati S, Sharma S. The heart of the ageing endurance athlete: the role of chronic coronary stress. Eur Heart J 2021; 42: 2737-2744
• 26 Netto J, Teren A, Burkhardt R. et al. Biomarkers for Non-Invasive Stratification of Coronary Artery Disease and Prognostic Impact on Long-Term Survival in Patients with Stable Coronary Heart Disease. Nutrients 2022; 14: 3433
• 27 Mahmod M, Pal N, Rayner J. et al. The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2018; 20: 88
• 28 Zhao H, Huang R, Jiang M. et al. Myocardial Tissue-Level Characteristics of Adults With Metabolically Healthy Obesity. JACC Cardiovasc Imaging 2023; 16: 889-901
• 29 Zhang Y, Zhang X, Wang Y. et al. Relationship between diffuse fibrosis assessed by CMR and depressed myocardial strain in different stages of heart failure. Eur J Radiology 2023; 164: 110848
• 30 Fujikura K, Arai AE. Correlation Between Cardiovascular Magnetic Resonance and Echocardiography in Assessment of Diastolic Function. JACC Cardiovasc Imaging 2021; 14: 1879-1880
• 31 Ramos JG, Fyrdahl A, Wieslander B. et al. Comprehensive Cardiovascular Magnetic Resonance Diastolic Dysfunction Grading Shows Very Good Agreement Compared With Echocardiography. JACC Cardiovasc Imaging 2020; 13: 2530-2542