{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:23:10Z","timestamp":1792794190039,"version":"4.5.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003130","name":"research foundation Flanders","doi-asserted-by":"publisher","award":["T003717N"],"award-info":[{"award-number":["T003717N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Health and Medical Research Council of Australia","award":["APP1130353"],"award-info":[{"award-number":["APP1130353"]}],"id":[{"id":"https:\/\/ror.org\/011kf5r70","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Abbott Belgium"},{"name":"Boston Scientific Belgium","award":["1189325N"],"award-info":[{"award-number":["1189325N"]}]},{"name":"Royal Australian College of Physicians Research Entry Scholarship","award":["2023RES00039"],"award-info":[{"award-number":["2023RES00039"]}],"id":[{"id":"https:\/\/ror.org\/047hk9367","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Health and Medical Research Council Postgraduate Scholarship","award":["2031119"],"award-info":[{"award-number":["2031119"]}],"id":[{"id":"https:\/\/ror.org\/011kf5r70","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Heart Foundation PhD Scholarship","award":["107659"],"award-info":[{"award-number":["107659"]}]},{"name":"Australian Government Research Training Program Scholarship.","id":[{"id":"https:\/\/ror.org\/0314h5y94","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The prevalence of ventricular fibrosis and its association with ventricular arrhythmias (VAs) and reduced ventricular systolic function in endurance athletes remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We evaluated 296 young [median age 19 (17\u201322)] and 138 middle-aged [56 (50\u201360)] male endurance athletes, alongside 66 middle-aged non-athletic controls [54 (49\u201360)], 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 &amp;lt; 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), &amp;gt;100 premature ventricular complexes\/24\u2005h (13 vs. 5%, P = 0.004), multifocal ventricular ectopy (11 vs. 4%, P = 0.003), and complex ventricular ectopy (25 vs. 10%, P &amp;lt; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay summary<\/jats:title>\n                    <jats:p>We studied young and middle-aged male endurance athletes and non-athletes using heart magnetic resonance imaging scans and 24\u2005h 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 \u2018non-hinge-point\u2019 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\u2019s lower chambers).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf715","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T13:18:33Z","timestamp":1762435113000},"page":"1405-1416","source":"Crossref","is-referenced-by-count":7,"title":["Myocardial fibrosis and its relationship with ventricular arrhythmias and reduced ventricular systolic function in young and veteran endurance athletes"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1452-6276","authenticated-orcid":false,"given":"Jarne","family":"De Paepe","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven B-3000 ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospitals Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8459-2140","authenticated-orcid":false,"given":"Paolo","family":"D\u2019Ambrosio","sequence":"additional","affiliation":[{"name":"Heart, Exercise and Research Trials (HEART) lab, St Vincent\u2019s Institute , Melbourne, VIC ,","place":["Australia"]},{"name":"Department of Cardiology, Royal Melbourne Hospital , Melbourne, VIC ,","place":["Australia"]},{"name":"Department of Medicine, The University of Melbourne , Melbourne, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3163-4781","authenticated-orcid":false,"given":"Ruben","family":"De Bosscher","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven B-3000 ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospitals Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3903-5051","authenticated-orcid":false,"given":"Youri","family":"Bekhuis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven B-3000 ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospitals Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6287-5085","authenticated-orcid":false,"given":"Rik","family":"Pauwels","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven B-3000 ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospitals Leuven , Leuven ,","place":["Belgium"]},{"name":"Department of Cardiology, Hartcentrum , Jessa Ziekenhuis, Hasselt ,","place":["Belgium"]},{"name":"Faculty of Medicine and Life Sciences, Cardiology and Organ Systems, Hasselt University , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7864-2968","authenticated-orcid":false,"given":"Christophe","family":"Dausin","sequence":"additional","affiliation":[{"name":"Department of Movement Sciences, KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3176-6751","authenticated-orcid":false,"given":"Kristel","family":"Janssens","sequence":"additional","affiliation":[{"name":"Heart, Exercise and Research Trials (HEART) lab, St Vincent\u2019s Institute , Melbourne, VIC ,","place":["Australia"]},{"name":"School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney , Kensington, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1475-2222","authenticated-orcid":false,"given":"Amy","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Heart, Exercise and Research Trials (HEART) lab, St Vincent\u2019s Institute , Melbourne, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5951-4239","authenticated-orcid":false,"given":"Adrian","family":"Elliott","sequence":"additional","affiliation":[{"name":"Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital , Adelaide ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4661-4732","authenticated-orcid":false,"given":"Caroline M","family":"Van De Heyning","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Antwerp , Antwerpen ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospital Antwerp , Antwerp ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3803-8429","authenticated-orcid":false,"given":"Prashanthan","family":"Sanders","sequence":"additional","affiliation":[{"name":"Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital , Adelaide ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5369-5844","authenticated-orcid":false,"given":"Peter M","family":"Kistler","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of Melbourne , Melbourne, VIC ,","place":["Australia"]},{"name":"The Baker Heart and Diabetes Research Institute , Melbourne ,","place":["Australia"]},{"name":"Department of Medicine, Monash University , Clayton, VIC ,","place":["Australia"]},{"name":"Department of Cardiology, The Alfred Hospital , Melbourne, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6618-7184","authenticated-orcid":false,"given":"Jonathan M","family":"Kalman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital , Melbourne, VIC ,","place":["Australia"]},{"name":"Department of Medicine, The University of Melbourne , Melbourne, VIC ,","place":["Australia"]},{"name":"The Baker Heart and Diabetes Research Institute , Melbourne ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9010-9856","authenticated-orcid":false,"given":"Diane","family":"Fatkin","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney , Kensington, NSW ,","place":["Australia"]},{"name":"Victor Chang Cardiac Research Institute , Darlinghurst, NSW ,","place":["Australia"]},{"name":"Cardiology Department, St. Vincent\u2019s Hospital , Darlinghurst, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9301-8127","authenticated-orcid":false,"given":"Hein","family":"Heidbuchel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Antwerp , Antwerpen ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospital Antwerp , Antwerp ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7784-3610","authenticated-orcid":false,"given":"Lieven","family":"Herbots","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hartcentrum , Jessa Ziekenhuis, Hasselt ,","place":["Belgium"]},{"name":"Faculty of Medicine and Life Sciences, Cardiology and Organ Systems, Hasselt University , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5469-9609","authenticated-orcid":false,"given":"Rik","family":"Willems","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven B-3000 ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospitals Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8676-4874","authenticated-orcid":false,"given":"Tomas","family":"Robyns","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven B-3000 ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospitals Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9229-9489","authenticated-orcid":false,"given":"Olivier","family":"Ghekiere","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Life Sciences, Cardiology and Organ Systems, Hasselt University , Diepenbeek ,","place":["Belgium"]},{"name":"Department of Radiology, Jessa Ziekenhuis , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7495-9183","authenticated-orcid":false,"given":"Jan","family":"Bogaert","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospitals Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3906-3784","authenticated-orcid":false,"given":"Andr\u00e9","family":"La Gerche","sequence":"additional","affiliation":[{"name":"Heart, Exercise and Research Trials (HEART) lab, St Vincent\u2019s Institute , Melbourne, VIC ,","place":["Australia"]},{"name":"Department of Medicine, The University of Melbourne , Melbourne, VIC ,","place":["Australia"]},{"name":"HEART Lab, Victor Chang Cardiovascular Research Institute , Darlinghurst, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8261-6666","authenticated-orcid":false,"given":"Guido","family":"Claessen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven B-3000 ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospitals Leuven , Leuven ,","place":["Belgium"]},{"name":"Department of Cardiology, Hartcentrum , Jessa Ziekenhuis, Hasselt ,","place":["Belgium"]},{"name":"Faculty of Medicine and Life Sciences, Cardiology and Organ Systems, Hasselt University , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Pro@Heart Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie","family":"Van Soest","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piet","family":"Claus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Sinnaeve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Claeys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaatje","family":"Goetschalckx","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Van Puyvelde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert","family":"Vandenberk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hespel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Dymarkowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Dresselaers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Delpire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hielko","family":"Miljoen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasper","family":"Favere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Paelinck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorien","family":"Vermeulen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Witvrouwen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert Op't","family":"Eijnde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Thijs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vanvoorden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristof","family":"Lefebvre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Rowe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Paratz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria J","family":"Brosnan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L","family":"Prior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"2026060301584889300_zwaf715-B1","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1161\/CIRCULATIONAHA.110.938852","article-title":"Exercise capacity and mortality in older men","volume":"122","author":"Kokkinos","year":"2010","journal-title":"Circulation"},{"key":"2026060301584889300_zwaf715-B2","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1152\/japplphysiol.01280.2010","article-title":"Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes","volume":"110","author":"Wilson","year":"2011","journal-title":"J Appl Physiol"},{"key":"2026060301584889300_zwaf715-B3","doi-asserted-by":"crossref","first-page":"14640","DOI":"10.1038\/s41598-023-40252-z","article-title":"Identification of non-ischaemic fibrosis in male veteran endurance athletes, mechanisms and association with premature ventricular beats","volume":"13","author":"Farooq","year":"2023","journal-title":"Sci Rep"},{"key":"2026060301584889300_zwaf715-B4","doi-asserted-by":"crossref","first-page":"131382","DOI":"10.1016\/j.ijcard.2023.131382","article-title":"Cardiac magnetic resonance assessment of athletic myocardial fibrosis; benign bystander or malignant marker?","volume":"394","author":"Javed","year":"2024","journal-title":"Int J Cardiol"},{"key":"2026060301584889300_zwaf715-B5","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12968-020-00660-w","article-title":"Prevalence and pattern of cardiovascular magnetic resonance late gadolinium enhancement in highly trained endurance athletes","volume":"22","author":"Domenech-Ximenos","year":"2020","journal-title":"J Cardiovasc Magn Reson"},{"key":"2026060301584889300_zwaf715-B6","doi-asserted-by":"crossref","first-page":"4536","DOI":"10.3390\/jcm13154536","article-title":"Myocardial fibrosis in young and veteran athletes: evidence from a systematic review of the current literature","volume":"13","author":"Allwood","year":"2024","journal-title":"J Clin Med"},{"key":"2026060301584889300_zwaf715-B7","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1002\/clc.23360","article-title":"Myocardial fibrosis in athletes\u2014current perspective","volume":"43","author":"Ma\u0142ek","year":"2020","journal-title":"Clin Cardiol"},{"key":"2026060301584889300_zwaf715-B8","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1136\/bjsports-2014-094546","article-title":"Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie?","volume":"50","author":"Schnell","year":"2016","journal-title":"Br J Sports Med"},{"key":"2026060301584889300_zwaf715-B9","doi-asserted-by":"crossref","first-page":"e004229","DOI":"10.1161\/CIRCEP.116.004229","article-title":"Nonischemic left ventricular scar as a substrate of life-threatening ventricular arrhythmias and sudden cardiac death in competitive athletes","volume":"9","author":"Zorzi","year":"2016","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026060301584889300_zwaf715-B10","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1093\/ehjci\/jey050","article-title":"Exercise cardiac magnetic resonance to differentiate athlete\u2019s heart from structural heart disease","volume":"19","author":"Claessen","year":"2018","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026060301584889300_zwaf715-B11","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1148\/radiol.2511081118","article-title":"Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners","volume":"251","author":"Breuckmann","year":"2009","journal-title":"Radiology"},{"key":"2026060301584889300_zwaf715-B12","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1007\/s00380-012-0289-7","article-title":"Comparison of morphological and functional adaptations of the heart in highly trained triathletes and long-distance runners using cardiac magnetic resonance imaging","volume":"28","author":"Franzen","year":"2013","journal-title":"Heart Vessels"},{"key":"2026060301584889300_zwaf715-B13","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1093\/eurheartj\/ehr397","article-title":"Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes","volume":"33","author":"La Gerche","year":"2012","journal-title":"Eur Heart J"},{"key":"2026060301584889300_zwaf715-B14","doi-asserted-by":"crossref","first-page":"e001048","DOI":"10.1136\/bmjsem-2021-001048","article-title":"Endurance exercise and the risk of cardiovascular pathology in men: a comparison between lifelong and late-onset endurance training and a non-athletic lifestyle\u2014rationale and design of the Master@Heart study, a prospective cohort trial","volume":"7","author":"De Bosscher","year":"2021","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2026060301584889300_zwaf715-B15","doi-asserted-by":"crossref","first-page":"e001309","DOI":"10.1136\/bmjsem-2022-001309","article-title":"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","volume":"8","author":"De Bosscher","year":"2022","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2026060301584889300_zwaf715-B16","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1016\/j.jcmg.2018.09.021","article-title":"Cardiac magnetic resonance normal reference values of biventricular size and function in male athlete\u2019s heart","volume":"12","author":"D\u2019Ascenzi","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026060301584889300_zwaf715-B17","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1093\/eurheartj\/ehx532","article-title":"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\u2019s heart","volume":"39","author":"Pelliccia","year":"2018","journal-title":"Eur Heart J"},{"key":"2026060301584889300_zwaf715-B18","volume-title":"Principles of Exercise Testing and Interpretation","author":"Wasserman","year":"2011","edition":"5th ed"},{"key":"2026060301584889300_zwaf715-B19","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1161\/CIRCULATIONAHA.119.042434","article-title":"Evaluation and management of premature ventricular complexes","volume":"141","author":"Marcus","year":"2020","journal-title":"Circulation"},{"key":"2026060301584889300_zwaf715-B20","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1161\/CIRCULATIONAHA.110.937821","article-title":"Correlates of echocardiographic indices of cardiac remodeling over the adult life course: longitudinal observations from the Framingham heart study","volume":"122","author":"Cheng","year":"2010","journal-title":"Circulation"},{"key":"2026060301584889300_zwaf715-B21","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1093\/eurheartj\/ehn163","article-title":"Running: the risk of coronary events: prevalence and prognostic relevance of coronary atherosclerosis in marathon runners","volume":"29","author":"Mohlenkamp","year":"2008","journal-title":"Eur Heart J"},{"key":"2026060301584889300_zwaf715-B22","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1161\/CIRCULATIONAHA.116.026964","article-title":"Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile","volume":"136","author":"Merghani","year":"2017","journal-title":"Circulation"},{"key":"2026060301584889300_zwaf715-B23","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/j.jcmg.2017.09.016","article-title":"Myocardial fibrosis in competitive triathletes detected by contrast-enhanced CMR correlates with exercise-induced hypertension and competition history","volume":"11","author":"Tahir","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026060301584889300_zwaf715-B24","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1016\/j.jacc.2016.02.062","article-title":"Etiology of sudden death in sports","volume":"67","author":"Finocchiaro","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2026060301584889300_zwaf715-B25","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1136\/bjsports-2020-102666","article-title":"Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study","volume":"55","author":"Peterson","year":"2021","journal-title":"Br J Sports Med"},{"key":"2026060301584889300_zwaf715-B26","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1177\/2047487319890973","article-title":"Screening young athletes for diseases at risk of sudden cardiac death: role of stress testing for ventricular arrhythmias","volume":"27","author":"Zorzi","year":"2020","journal-title":"Eur J Prev Cardiol"},{"key":"2026060301584889300_zwaf715-B27","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1136\/bjsports-2018-100529","article-title":"How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm","volume":"54","author":"Corrado","year":"2020","journal-title":"Br J Sports Med"},{"key":"2026060301584889300_zwaf715-B28","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.jacep.2019.10.015","article-title":"Risk stratification of patients with apparently idiopathic premature ventricular contractions","volume":"6","author":"Muser","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"key":"2026060301584889300_zwaf715-B29","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/sms.12679","article-title":"The prevalence and clinical significance of premature ventricular beats in the athlete","volume":"27","author":"D\u2019Ascenzi","year":"2017","journal-title":"Scand J Med Sci Sports"},{"key":"2026060301584889300_zwaf715-B30","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/europace\/euaa106","article-title":"Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators","volume":"23","author":"Heidbuchel","year":"2021","journal-title":"Europace"},{"key":"2026060301584889300_zwaf715-B31","doi-asserted-by":"crossref","first-page":"euad225","DOI":"10.1093\/europace\/euad255","article-title":"Ventricular arrhythmias recorded on 12-lead ambulatory electrocardiogram monitoring in healthy volunteer athletes and controls: what is common and what is not","volume":"25","author":"Graziano","year":"2023","journal-title":"Europace"},{"key":"2026060301584889300_zwaf715-B32","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1177\/2047487318797396","article-title":"Burden of ventricular arrhythmias at 12-lead 24-hour ambulatory ECG monitoring in middle-aged endurance athletes versus sedentary controls","volume":"25","author":"Zorzi","year":"2018","journal-title":"Eur J Prev Cardiol"},{"key":"2026060301584889300_zwaf715-B33","doi-asserted-by":"crossref","first-page":"e009171","DOI":"10.1161\/JAHA.118.009171","article-title":"Ventricular arrhythmias in young competitive athletes: prevalence, determinants, and underlying substrate","volume":"7","author":"Zorzi","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2026060301584889300_zwaf715-B34","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1016\/j.jcmg.2018.07.015","article-title":"Outcome in dilated cardiomyopathy related to the extent, location, and pattern of late gadolinium enhancement","volume":"12","author":"Halliday","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026060301584889300_zwaf715-B35","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1001\/jamacardio.2024.2824","article-title":"Myocardial scarring and sudden cardiac death in young patients with hypertrophic cardiomyopathy","volume":"9","author":"Chan","year":"2024","journal-title":"JAMA Cardiol"},{"key":"2026060301584889300_zwaf715-B36","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.echo.2019.03.017","article-title":"Apparent ventricular dysfunction in elite young athletes: another form of cardiac adaptation of the athlete\u2019s heart","volume":"32","author":"Boraita","year":"2019","journal-title":"J Am Soc Echocardiogr"},{"key":"2026060301584889300_zwaf715-B37","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jacc.2004.02.057","article-title":"Serial left ventricular adaptations in world-class professional cyclists","volume":"44","author":"Abergel","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2026060301584889300_zwaf715-B38","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1161\/CIRCULATIONAHA.122.063777","article-title":"Reduced ejection fraction in elite endurance athletes: clinical and genetic overlap with dilated cardiomyopathy","volume":"149","author":"Claessen","year":"2023","journal-title":"Circulation"},{"key":"2026060301584889300_zwaf715-B39","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1253\/circj.CJ-18-1388","article-title":"Impact of myocardial fibrosis on left ventricular function evaluated by feature-tracking myocardial strain cardiac magnetic resonance in competitive male triathletes with normal ejection fraction","volume":"83","author":"Tahir","year":"2019","journal-title":"Circ J"},{"key":"2026060301584889300_zwaf715-B40","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1161\/CIRCULATIONAHA.114.008141","article-title":"Can intensive exercise harm the heart?","volume":"130","author":"La Gerche","year":"2014","journal-title":"Circulation"},{"key":"2026060301584889300_zwaf715-B41","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jcmg.2020.09.014","article-title":"Exercise-induced arrhythmogenic (right ventricular) cardiomyopathy is real\u2026if you consider it","volume":"14","author":"La Gerche","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026060301584889300_zwaf715-B42","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/S0195-668X(03)00282-3","article-title":"High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias role of an electrophysiologic study in risk stratification","volume":"24","author":"Heidb\u00fcchel","year":"2003","journal-title":"Eur Heart J"},{"key":"2026060301584889300_zwaf715-B43","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/eurheartj\/ehl468","article-title":"Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment","volume":"28","author":"Ector","year":"2007","journal-title":"Eur Heart J"},{"key":"2026060301584889300_zwaf715-B44","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1093\/eurheartj\/ehv202","article-title":"Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes","volume":"36","author":"La Gerche","year":"2015","journal-title":"Eur Heart J"},{"key":"2026060301584889300_zwaf715-B45","first-page":"282","article-title":"Right ventricular strain rate during exercise accurately identifies male athletes with right ventricular arrhythmias","volume":"21","author":"Claeys","year":"2019","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026060301584889300_zwaf715-B46","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1136\/hrt.2009.189621","article-title":"Lower than expected desmosomal gene mutation prevalence in endurance athletes with complex ventricular arrhythmias of right ventricular origin","volume":"96","author":"La Gerche","year":"2010","journal-title":"Heart"},{"key":"2026060301584889300_zwaf715-B47","doi-asserted-by":"crossref","first-page":"e001471","DOI":"10.1161\/JAHA.114.001471","article-title":"Exercise has a disproportionate role in the pathogenesis of arrhythmogenic right ventricular dysplasia\/cardiomyopathy in patients without desmosomal mutations","volume":"3","author":"Sawant","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2026060301584889300_zwaf715-B48","doi-asserted-by":"crossref","first-page":"e001309","DOI":"10.1136\/bmjsem-2022-001309","article-title":"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","volume":"8","author":"De Bosscher","year":"2022","journal-title":"BMJ Open Sport Exerc Med"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwaf715\/66004064\/zwaf715.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/33\/8\/1405\/66004064\/zwaf715.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/33\/8\/1405\/66004064\/zwaf715.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:58:59Z","timestamp":1780466339000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/article\/33\/8\/1405\/8383467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":48,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,12,18]]},"published-print":{"date-parts":[[2026,6,3]]}},"URL":"https:\/\/doi.org\/10.1093\/eurjpc\/zwaf715","relation":{},"ISSN":["2047-4873","2047-4881"],"issn-type":[{"value":"2047-4873","type":"print"},{"value":"2047-4881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2025,12,18]]}}}