{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:19:52Z","timestamp":1778775592703,"version":"3.51.4"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T00:00:00Z","timestamp":1649980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Cardiac magnetic resonance (CMR) is a second-line imaging test in cardiology. Balanced enlargement of heart chambers called athlete\u2019s heart (AH) is a part of physiological adaptation to regular physical activity. The aim of this study was to evaluate the diagnostic utility of CMR in athletes with suspected structural heart disease (SHD) and to analyse the relation between the coexistence of AH and SHD. We wanted to assess whether the presence of AH phenotype could be considered as a sign of a healthy heart less prone to development of SHD. This retrospective, single centre study included 154 consecutive athletes (57 non-amateur, all sports categories, 87% male, mean age 34 \u00b1 12 years) referred for CMR because of suspected SHD. The suspicion was based on existing guidelines including electrocardiographic and\/or echocardiographic changes suggestive of abnormality but without a formal diagnosis. CMR permitted establishment of a new diagnosis in 66 patients (42%). The main diagnoses included myocardial fibrosis typical for prior myocarditis (n = 21), hypertrophic cardiomyopathy (n = 17, including 6 apical forms), other cardiomyopathies (n = 10) and prior myocardial infarction (n = 6). Athlete\u2019s heart was diagnosed in 59 athletes (38%). The presence of pathologic late gadolinium enhancement (LGE) was found in 41 patients (27%) and was not higher in athletes without AH (32% vs. 19%, p = 0.08). Junction-point LGE was more prevalent in patients with AH phenotype (22% vs. 9%, p = 0.02). Patients without AH were not more likely to be diagnosed with SHD than those with AH (49% vs. 32%, p = 0.05). Based on the results of CMR and other tests, three patients (2%) were referred for ICD implantation for the primary prevention of sudden cardiac death with one patient experiencing adequate intervention during follow-up. The inclusion of CMR into the diagnostic process leads to a new diagnosis in many athletes with suspicion of SHD and equivocal routine tests. Athletes with AH pattern are equally likely to be diagnosed with SHD in comparison to those without AH phenotype. This shows that the development of AH and SHD can occur in parallel, which makes differential diagnosis in this group of patients more challenging.<\/jats:p>","DOI":"10.3390\/ijerph19084829","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T04:21:28Z","timestamp":1650255688000},"page":"4829","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete\u2019s Heart and Suspected Structural Heart Disease"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9586-0163","authenticated-orcid":false,"given":"\u0141ukasz A.","family":"Ma\u0142ek","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, 04-635 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Mi\u0142osz-Wieczorek","sequence":"additional","affiliation":[{"name":"Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, 04-635 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdalena","family":"Marczak","sequence":"additional","affiliation":[{"name":"Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, 04-635 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.jcmg.2017.08.005","article-title":"Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy","volume":"10","author":"Patel","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s41747-021-00208-2","article-title":"CMR for myocardial characterization in ischemic heart disease: State-of-the-art and future developments","volume":"5","author":"Emrich","year":"2021","journal-title":"Eur. Radiol. Exp."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Global Cardiovascular Magnetic Resonance Registry (GCMR), Investigators, Kwong, R.Y., Petersen, S.E., Schulz-Menger, J., Arai, A.E., Bingham, S.E., Chen, Y., Choi, Y.L., Cury, R.C., and Ferreira, V.M. (2017). The global cardiovascular magnetic resonance registry (GCMR) of the society for cardiovascular magnetic resonance (SCMR): Its goals, rationale, data infrastructure, and current developments. J. Cardiovasc. Magn. Reson., 19, 23.","DOI":"10.1186\/s12968-016-0321-7"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1002\/clc.23360","article-title":"Myocardial fibrosis in athletes-Current perspective","volume":"43","year":"2020","journal-title":"Clin. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1093\/eurheartj\/ehw631","article-title":"International recommendations for electrocardiographic interpretation in athletes","volume":"39","author":"Sharma","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/ehjci\/jeu323","article-title":"The multi-modality cardiac imaging approach to the Athlete\u2019s heart: An expert consensus of the European Association of Cardiovascular Imaging","volume":"16","author":"Galderisi","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_8","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":"ref_9","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12968-017-0327-9","article-title":"Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort","volume":"19","author":"Petersen","year":"2017","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1177\/2047487320932018","article-title":"The use of cardiac imaging in the evaluation of athletes in the clinical practice: A survey by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology and University of Siena, in collaboration with the European Association of Cardiovascular Imaging, the European Heart Rhythm Association and the ESC Working Group on Myocardial and Pericardial Diseases","volume":"28","author":"Anselmi","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1093\/ehjci\/jeaa329","article-title":"Current use of cardiac magnetic resonance in tertiary referral centres for the diagnosis of cardiomyopathy: The ESC EORP Cardiomyopathy\/Myocarditis Registry","volume":"22","author":"Charron","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1002\/jmri.27513","article-title":"Cardiac involvement in consecutive elite athletes recovered from Covid-19: A magnetic resonance study","volume":"53","author":"Marczak","year":"2021","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1177\/2047487319852807","article-title":"Brief recommendations for participation in competitive sports of athletes with arterial hypertension: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC)","volume":"26","author":"Niebauer","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3158","DOI":"10.1016\/j.jacc.2018.09.072","article-title":"Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations","volume":"72","author":"Ferreira","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12968-015-0111-7","article-title":"Normal values for cardiovascular magnetic resonance in adults and children","volume":"17","author":"Maceira","year":"2015","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2968","DOI":"10.21037\/jtd.2018.04.141","article-title":"Native T1 and T2 mapping by cardiovascular magnetic resonance imaging in pressure overloaded left and right heart diseases","volume":"10","author":"Wang","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1532-429X-15-9","article-title":"European Cardiovascular Magnetic Resonance (EuroCMR) registry\u2014Multi national results from 57 centers in 15 countries","volume":"15","author":"Bruder","year":"2013","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e003454","DOI":"10.1161\/CIRCIMAGING.114.003454","article-title":"Clinical Profile of Athletes With Hypertrophic Cardiomyopathy","volume":"8","author":"Sheikh","year":"2015","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1016\/j.hlc.2018.03.023","article-title":"Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy: Progress and Pitfalls","volume":"27","author":"Oomen","year":"2018","journal-title":"Heart Lung Circ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1136\/heartjnl-2019-316147","article-title":"Differentiation between athlete\u2019s heart and dilatedcardiomyopathy in athletic individuals","volume":"106","author":"Millar","year":"2020","journal-title":"Heart"},{"key":"ref_22","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. Arrhythmia Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.humpath.2016.08.004","article-title":"Nonischemic left ventricular scar and cardiac sudden death in the young","volume":"58","author":"Giordano","year":"2016","journal-title":"Hum. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"585692","DOI":"10.3389\/fcvm.2020.585692","article-title":"Prevalence of Myocardial Fibrosis in Intensive Endurance Training Athletes: A Systematic Review and Meta-Analysis","volume":"7","author":"Zhang","year":"2020","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12968-018-0481-8","article-title":"Guidelines for training in cardiovascular magneticresonance (CMR)","volume":"20","author":"Kim","year":"2018","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1177\/2047487320909670","article-title":"Myocarditis in athletes: A clinical perspective","volume":"28","author":"Halle","year":"2020","journal-title":"Eur. J. Prev. Cardiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4829\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:55:02Z","timestamp":1760136902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,15]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19084829"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19084829","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,15]]}}}