Prevalence of Myocardial Fibrosis in Intensive Endurance Training Athletes: A Systematic Review and Meta-Analysis

Abstract

Objective: To review the published literature reporting on the incidence of myocardial fibrosis (MF) in high-intensity endurance athletes measured by late gadolinium enhancement (LGE) with cardiac magnetic resonance imaging (CMR). Methods: Five databases (PubMed, Cochrane Controlled Trials Register, EMBASE, Web of Science, and SPORTDiscus) were searched to obtain case cohort studies published before November 10, 2019. From 96 abstracts or reports extracted, 18 full-text articles were reviewed. The incidence of LGE was reported as outcome measures. Subgroup analysis was performed by age (under or above 50 years). Pooled estimates were obtained using a fixed-effects model. Results: After a full-text assessment, 12 studies involving 1,359 participants were included for analysis. Among them, 163/772 participants in the endurance athletes group showed LGE positive, compared with 19/587 participants in the comparison group. The results of the meta-analysis suggested that the prevalence of LGE was higher in the athletes group with long-term endurance exercise (OR 7.20;95%CI: 4.51-11.49). In addition, the same conclusion was drawn after the stratification of age. Conclusions: The available evidence demonstrates that high-intensity endurance athletes is associated with an increased incidence of LGE positive.

The Role of Cardiovascular Magnetic Resonance Imaging in the Assessment of Myocardial Fibrosis in Young and Veteran Athletes: Insights From a Meta-Analysis

“…All available evidence indicates that the prevalence of MF, as documented by LGE in CMR scans, is significantly higher in athletes compared to sedentary controls. The pooled frequency of 16.6% is lower than the 21.1% reported by Zhang et al (16), with the difference owed to the updated set of studies, which include new data, updated numbers from some research teams and exclude some previous, non-peer-reviewed datasets.…”

“…Although the underlying mechanisms are widely undetermined, the summarized evidence supported genetic predisposition, silent myocarditis, pulmonary artery pressure overload, and prolonged exercise-induced repetitive micro-injury as possible contributors (15). More recently, Zhang et al (16) performed a meta-analysis of athletic individuals and sedentary controls who underwent CMR, focusing however only on general MF prevalence without looking into different patterns, and without discriminating different athletic age groups, or sex-specific data. According to the results, 21.1% of athletes had evidence of LGE, compared to just 3.2% in sedentary controls.…”

“…In view of updated data on the topic of CMR based assessment, using both contrast and non-contrast techniques, we performed a revised systematic search and meta-analysis, with a three-fold aim: To focus on updated, peer-reviewed data, report a risk of bias assessment, which was unfortunately missing from the recent meta-analysis (16), and extract data on other CMR-derived techniques, such as native T1 mapping as a sensitive marker of interstitial fibrosis and ECV quantification, as marker of myocardial tissue remodeling, based on studies using both 1.5 and 3 Tesla (T) scanners. Of note, structured assessment of risk of bias and exclusion of low-quality data is crucial, since recruitment bias can…”

Leisure-time physical activities and the risk of cardiovascular mortality in the Malmö diet and Cancer study

“…These findings were corroborated in the present study; when runners were divided into tertiles, the largest risk reduction was found in the first tertile, although no U-trend was observed. In the context of the U-trend [ 21 ], it is notable that there are data suggesting an increased incidence of atrial fibrillation [ 22 ], a disease associated with both heart failure and cardioembolic stroke, myocardial fibrosis [ 23 ] and, infrequently, arrhythmogenic sudden death [ 24 ] in those involved in extreme physical activities. The greatest mortality benefit was reported to be achieved for individuals who were running and engaged in some other physical activity [ 25 ].…”

Cardiac Biomarkers and Autoantibodies in Endurance Athletes: Potential Similarities with Arrhythmogenic Cardiomyopathy Pathogenic Mechanisms

“…Exercise-induced myocardial fibrosis patterns are various and differ according to the age of the athletes [ 61 , 62 , 63 ]. Fibrosis is often found near the interventricular septum, especially in middle-aged and older athletes, and near the right ventricular insertion points, mainly in young athletes [ 4 , 5 , 61 ].…”