Cardiac magnetic resonance feature tracking in Olympic athletes: a myocardial deformation analysis

Athlete's heart induces extreme cardiovascular remodelling, generating challenges for the differential diagnosis with early stages of cardiomyopathies. Advanced cardiac function analysis could be helpful, but data on healthy athletes and the impact of sports disciplines are lacking. The study aims to describe myocardial deformation by cardiac magnetic resonance (CMR) in a cohort of Olympic athletes and to evaluate possible differences based on sports disciplines and sex.

A group of Olympic athletes with normal cardiovascular evaluation and a group of sedentary controls matched for age and sex underwent CMR without contrast administration. Cine images were post-processed for volumes and function evaluation and to assess bi-ventricular myocardial deformation parameters, as left ventricular global longitudinal and circumferential strain (LV-GLS and LV-GCS) and right ventricular GLS, by a dedicated feature-tracking (FT) software. Athletes were divided according to ESC sports classification and sex. Three hundred Olympic athletes (13% skill, 20% power, 25% mixed, 42% endurance, 58% male) and 42 untrained controls were enrolled. No significant differences were found between LV-GLS, LV-GCS, and RV-GLS when comparing different sports categories, except for a slightly lower LV-GLS in the endurance group compared to the skill one (P = 0.045). Athletes showed slightly lower bi-ventricular ejection fraction (P < 0.001) and LV-GCS (P < 0.001) than sedentary controls, while only endurance athletes showed significant differences in LV- and RV-GLS vs. the sedentary group (P = 0.002 and P = 0.001). Female athletes showed higher bi-ventricular GLS than males (P < 0.001 for LV- and RV-GLS).

Our results provided for the first time CMR-FT strain values in a large cohort of Olympic athletes free of cardiovascular abnormalities, according to type of sports. Endurance athletes showed the lowest LV-GLS values being significantly different vs. skill and sedentary controls. No other significant differences in myocardial deformation parameters between sports categories were found, but only based on sex.