Cardiac Ventricular Hinge Point LGE Is Highly Prevalent and Sex-Dependent in ELITE Athletes

Myocardial late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging has been described in older endurance athletes, particularly at the ventricular hinge point. However, data on young, elite athletes are lacking. We therefore quantified the prevalence of hinge point LGE (HP-LGE) in young elite-level athletes.

We investigated 309 (40% women; median age 25.1 [21.9-29.5] years) asymptomatic athletes included in the ELITE prospective cohort (Evaluation of Lifetime Participation in Intensive Top-level Sports and Exercise cohort), investigating cardiovascular screenings of elite (national-, international-, Olympic-, or Paralympic-) level athletes, including cardiac magnetic resonance imaging with short-axis cine imaging, LGE, and T1-mapping.

A total of 124 (40%) athletes had HP-LGE, with a higher prevalence in men compared with women (47% versus 30%; P=0.004). When indexed for body surface area, athletes with HP-LGE had greater left ventricle end-systolic volumes (53±11 mL/m² versus 51±11 mL/m²; P=0.037), right ventricle end-systolic volumes (56±12 mL/m² versus 53±11 mL/m²; P=0.020), lower left ventricle ejection fraction (55.5±5.0% versus 56.7±4.6%; P=0.035), lower right ventricle ejection fraction (53.9±5.0% versus 55.2±4.4%; P=0.021), and smaller estimated global left ventricle extracellular volumes (24.45±2.52% versus 25.27±2.59%; P=0.015). In multivariable regression analyses, male sex was strongly associated with HP-LGE (odds ratio, 3.07 [95% CI, 1.32-7.32]; P=0.010).

HP-LGE is a common finding in asymptomatic, elite athletes and is strongly associated with sex. Lower left ventricle ejection fraction is moderately associated with HP-LGE. Our study's HP-LGE prevalence indicates that HP-LGE should be interpreted as a feature of the athlete's heart.