T1 Mapping in Athletes

Cardiac adaptation to high-intensity exercise is well recognized and often termed the athlete’s heart. The characteristic features of athlete’s heart are increased left ventricular (LV) volume, increased LV wall thickness and mass, resting bradycardia, and ECG repolarization abnormalities.1 These changes are particularly associated with endurance training causing eccentric LV hypertrophy, whereas significant resistance training (eg, weight lifters) may lead to concentric LV hypertrophy. Although somewhat controversial, it is widely accepted that in the majority of athletes, these changes occur as a physiological response to exercise training; LV volumes and mass regress in subjects who stop training and decondition.2 However, there is an increasing number of reports in older veteran athletes that may suggest that some people who exercise intensely over many years develop myocardial fibrosis3 and have an increased risk of arrhythmias, particularly atrial fibrillation.4See Article by McDiarmid et al Difficulties may also arise in differentiating athlete’s heart from pathological cardiac conditions that are associated with sudden death, such as dilated and hypertrophic cardiomyopathy (HCM),5 in certain situations. Many countries and professional sports teams have implemented preparticipation sports screening programs, and because of the high prevalence of ECG abnormalities, a significant minority of athletes are referred for echocardiographic imaging. Similarly, healthy athletes with atypical cardiac symptoms are more likely to be referred for cardiac investigations because of high frequency of repolarization abnormalities. Cardiac magnetic resonance imaging (CMR) may be particularly useful in such situations because of the superiority over echocardiography to detect hypertrophy in the lateral segments and apical HCM.6 Another major strength of CMR is the …