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Cardiac Magnetic Resonance Normal Reference Values of Biventricular Size and Function in Male Athlete's Heart
Flavio D'Ascenzi1, Francesca Anselmi1, Pietro Piu2
1Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
Insights
This meta-analysis establishes normal cardiac magnetic resonance (CMR) reference values for biventricular size and function in competitive athletes, aiding in differentiating training adaptations from disease.
Area of Science:
- Cardiology
- Sports Medicine
- Medical Imaging
Background:
- Exercise leads to cardiac chamber enlargement in athletes, mimicking pathological conditions like cardiomyopathies.
- Cardiac magnetic resonance (CMR) is increasingly used to exclude cardiac pathology in athletes.
- Established normal reference values for athletes' biventricular parameters using CMR are lacking.
Purpose of the Study:
- To derive normal reference values for biventricular size and function in competitive athletes using CMR.
- To provide a basis for accurate interpretation of CMR in athletic populations.
Main Methods:
- A systematic review of studies using CMR to assess biventricular size and function in athletes was conducted.
- Athletes were categorized by sport type (endurance, combined, mixed).
- The influence of training volume on cardiac parameters was analyzed.
Main Results:
- Data from 27 studies involving 983 athletes were analyzed.
- Normal reference values for biventricular size and function in male athletes, stratified by sport, were determined.
- Higher training volume correlated with greater right ventricular remodeling, but biventricular function remained unaffected.
Conclusions:
- This meta-analysis provides crucial normal reference values for biventricular parameters in competitive athletes via CMR.
- These values can serve as a valuable tool to distinguish physiological adaptations from cardiomyopathies in athletes.
- The findings support the use of athlete-specific CMR reference ranges over general population standards.
Objectives:
The aim of this meta-analysis was to derive normal reference values of biventricular size and function estimated by cardiac magnetic resonance (CMR) in competitive athletes.
Background:
Exercise-induced enlargement of cardiac chambers is commonly observed in competitive athletes. However, ventricular dilatation is also a common phenotypic expression of life-threatening cardiomyopathies. The use of CMR for the exclusion of pathology is growing. However, normal reference values have not been established for athletes.
Methods:
The authors conducted a systematic review of English-language studies in the MEDLINE, Scopus, and Cochrane databases investigating biventricular size and function by CMR in athletes. Athletes were divided into endurance, combined, and mixed groups according to the sport practiced. The potential impact of training volume was also evaluated.
Results:
Twenty-seven studies and 983 competitive athletes were included for CMR quantification of biventricular size and function. In this review, normal reference values are presented for biventricular size and function to be applied to male competitive athletes according to the disciplines practiced. A significant impact of training volume was demonstrated for the right ventricle: athletes practicing the largest number of training hours per week were those exhibiting the greatest degree of right ventricular remodeling. Notably, biventricular function was not significantly affected by training volume.
Conclusions:
The present meta-analysis defines the normal limits of biventricular size and function estimated by CMR in competitive athletes. The authors suggest using these normal reference values as an alternative to standard upper limits derived from the general population when interpreting CMR images in athletes.