"skipMainNavigation"
closeDrawerMenuopenDrawerMenu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
Radiology
Menu
  • Information
    • Previous
    Next
    Original Research

    Myocardial Late Gadolinium Enhancement: Prevalence, Pattern, and Prognostic Relevance in Marathon Runners

    Published Online:Apr 1 2009https://doi.org/10.1148/radiol.2511081118

    Abstract

    Purpose: To prospectively analyze the myocardial distribution of late gadolinium enhancement (LGE) with delayed-enhancement cardiac magnetic resonance (MR) imaging, to compare the prevalence of this distribution in nonprofessional male marathon runners with that in asymptomatic control subjects, and to examine the prognostic role of LGE.

    Materials and Methods: Institutional review board and ethics committee approval were obtained for this study, and all subjects provided written informed consent. Two-dimensional inversion-recovery segmented k-space gradient-echo MR sequences were performed after administration of a gadolinium-containing contrast agent in 102 ostensibly healthy male runners aged 50–72 years who had completed at least five marathons during the past 3 years and in 102 age-matched control subjects. Predominantly subendocardial regions of LGE typical of myocardial infarction (hereafter, coronary artery disease [CAD] pattern) were distinguished from a predominantly midmyocardial patchy pattern of LGE (hereafter, non–CAD pattern). Marathon runners with LGE underwent repeat cardiac MR imaging and additional adenosine perfusion imaging. Runners were followed up for a mean of 21 months ± 3 (standard deviation) after initial presentation. The χ2, Fisher exact, and McNemar exact tests were used for comparisons. Event-free survival rates were estimated with the Kaplan-Meier method, and overall group differences were evaluated with log-rank statistics.

    Results: Of the 102 runners, five had a CAD pattern of LGE, and seven had a non–CAD pattern of LGE. The CAD pattern of LGE was located in the territory of the left anterior descending coronary artery more frequently than was the non–CAD pattern (P = .0027, Fisher exact test). The prevalence of LGE in runners was higher than that in age-matched control subjects (12% vs 4%; P = .077, McNemar exact test). The event-free survival rate was lower in runners with myocardial LGE than in those without myocardial LGE (P < .0001, log-rank test).

    Conclusion: Ostensibly healthy marathon runners have an unexpectedly high rate of myocardial LGE, and this may have diagnostic and prognostic relevance.

    Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/251/1/50/DC1

    © RSNA, 2009

    References

    • 1 Thompson PD, Franklin BA, Balady GJ, et al. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 2007; 115(17): 2358–2368. Crossref, Medline, Google Scholar
    • 2 Maron BJ. The paradox of exercise. N Engl J Med 2000;343(19):1409–1411. Crossref, Medline, Google Scholar
    • 3 Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 2000;343(19):1355–1361. Crossref, Medline, Google Scholar
    • 4 Iwasaki K, Zhang R, Zuckerman JH, Levine BD. Dose-response relationship of the cardiovascular adaptation to endurance training in healthy adults: how much training for what benefit? J Appl Physiol 2003;95(4):1575–1583. Crossref, Medline, Google Scholar
    • 5 Hoogsteen J, Hoogeveen A, Schaffers H, Wijn PF, van Hemel NM, van der Wall EE. Myocardial adaptation in different endurance sports: an echocardiographic study. Int J Cardiovasc Imaging 2004;20(1):19–26. Crossref, Medline, Google Scholar
    • 6 Siegel AJ. Relative risk of sudden cardiac death during marathon running. Arch Intern Med 1997;157(11):1269–1270. Crossref, Medline, Google Scholar
    • 7 Willich SN, Lewis M, Lowel H, Arntz HR, Schubert F, Schroder R; and the Triggers and Mechanisms of Myocardial Infarction Study Group. Physical exertion as a trigger of acute myocardial infarction. N Engl J Med 1993;329(23):1684–1690. Crossref, Medline, Google Scholar
    • 8 Roberts WO, Maron BJ. Evidence for decreasing occurrence of sudden cardiac death associated with the marathon. J Am Coll Cardiol 2005;46(7):1373–1374. Crossref, Medline, Google Scholar
    • 9 Neilan TG, Yoerger DM, Douglas PS, et al. Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J 2006;27(9):1079–1084. Crossref, Medline, Google Scholar
    • 10 Möhlenkamp S, Schmermund A, Kröger K, et al. Coronary atherosclerosis and cardiovascular risk in masters male marathon runners: rationale and design of the “marathon study”. Herz 2006;31(6):575–585. Crossref, Medline, Google Scholar
    • 11 Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 2006;114(15):1633–1644. Crossref, Medline, Google Scholar
    • 12 Rehwald WG, Fieno DS, Chen EL, Kim RJ, Judd RM. Myocardial magnetic resonance imaging contrast agent concentrations after reversible and irreversible ischemic injury. Circulation 2002;105(2):224–229. Crossref, Medline, Google Scholar
    • 13 Kim RJ, Fieno DS, Parrish TB, et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 1999;100(19):1992–2002. Crossref, Medline, Google Scholar
    • 14 Kwong RY, Chan AK, Brown KA, et al. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 2006;113(23):2733–2743. Crossref, Medline, Google Scholar
    • 15 Barbier J, Ville N, Kervio G, Walther G, Carre F. Sports-specific features of athlete's heart and their relation to echocardiographic parameters. Herz 2006;31(6):531–543. Crossref, Medline, Google Scholar
    • 16 Möhlenkamp S, Lehmann N, Breuckmann F, et al. Running: the risk of coronary events—prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J 2008;29(15):1903–1910. Crossref, Medline, Google Scholar
    • 17 Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105(4):539–542. Crossref, Medline, Google Scholar
    • 18 Ladd SC, Wanke I, Gizewski ER, Forsting M. First results of a prospective whole-body MR screening study [abstr]. Eur J Radiol 2007;17(suppl):202. Google Scholar
    • 19 Möhlenkamp S, Böse D, Mahabadi AA, Heusch G, Erbel R. On the paradox of exercise: coronary atherosclerosis in an apparently healthy marathon runner. Nat Clin Pract Cardiovasc Med 2007;4(7):396–401. Crossref, Medline, Google Scholar
    • 20 Hunold P, Schlosser T, Vogt FM, et al. Myocardial late enhancement in contrast-enhanced cardiac MRI: distinction between infarction scar and non-infarction-related disease. AJR Am J Roentgenol 2005;184(5):1420–1426. Crossref, Medline, Google Scholar
    • 21 Kim RJ, Judd RM. Gadolinium-enhanced magnetic resonance imaging in hypertrophic cardiomyopathy: in vivo imaging of the pathologic substrate for premature cardiac death? J Am Coll Cardiol 2003;41(9):1568–1572. Crossref, Medline, Google Scholar
    • 22 Breuckmann F, Nassenstein K, Konietzka I, et al. The role of high-resolution cardiac magnetic resonance imaging in the detection of coronary microembolization: preliminary results in an animal model. Clin Res Cardiol 2007;96(suppl 1):1250. Google Scholar
    • 23 Porto I, Selvanayagam JB, Van Gaal WJ, et al. Plaque volume and occurrence and location of peri-procedural myocardial necrosis after percutaneous coronary intervention: insights from delayed-enhancement magnetic resonance imaging, thrombolysis in myocardial infarction myocardial perfusion grade analysis, and intravascular ultrasound. Circulation 2006;114(7):662–669. Crossref, Medline, Google Scholar
    • 24 Heusch G, Schulz R, Haude M, Erbel R. Coronary microembolization. J Mol Cell Cardiol 2004;37(1):23–31. Crossref, Medline, Google Scholar
    • 25 Bärtsch P. Platelet activation with exercise and risk of cardiac events. Lancet 1999;354(9192):1747–1748. Crossref, Medline, Google Scholar
    • 26 Siegel AJ, Stec JJ, Lipinska I, et al. Effect of marathon running on inflammatory and hemostatic markers. Am J Cardiol 2001;88(8):918–920. Crossref, Medline, Google Scholar
    • 27 Möhlenkamp S, Beighley PE, Pfeifer EA, Behrenbeck TR, Sheedy PF 2nd, Ritman EL. Intramyocardial blood volume, perfusion and transit time in response to embolization of different sized microvessels. Cardiovasc Res 2003;57(3):843–852. Crossref, Medline, Google Scholar
    • 28 Bogaert J, Goldstein M, Tannouri F, Golzarian J, Dymarkowski S. Original report: late myocardial enhancement in hypertrophic cardiomyopathy with contrast-enhanced MR imaging. AJR Am J Roentgenol 2003;180(4):981–985. Crossref, Medline, Google Scholar
    • 29 Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004;109(10):1250–1258. Crossref, Medline, Google Scholar
    • 30 Möhlenkamp S, Hort W, Ge J, Erbel R. Update on myocardial bridging. Circulation 2002;106(20):2616–2622. Crossref, Medline, Google Scholar
    • 31 Baldesberger S, Bauersfeld U, Candinas R, et al. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J 2008;29(1):71–78. Medline, Google Scholar

    Article History

    Published in print: 2009