CARDIOVASCULAR MAGNETIC RESONANCE ADVANCED IMAGING TECHNIQUES IN COMPETITIVE ATHLETES

BACKGROUND: Cardiovascular Magnetic Resonance is the primary imaging modality for the non-invasive myocardial tissue characterization, and it is considered as the gold standard technique for quantifying cardiac function, myocardial volumes and mass.Until now, most of the CMR studies in athletes have been based principally on qualitative or semiquantitative techniques for detecting oedema and/or macroscopic fibrosis by T2-weighted or late-gadolinium enhancement (LGE) sequences. Modern-day mapping techniques are significantly changing the clinical management in the patients with cardiac involvement. Moreover, in recent years, the development of feature tracking analysis has allowed a better evaluation of heart function. Thus, advanced imaging techniques are aiming to close the gaps in diagnostic accuracy in trained subjects, as there are still various uncertainties in the differential diagnosis of the athlete’s heart with other cardiac diseases. objectives: The first aim of this study is to perform strain analysis in a population of competitive athletes who underwent CMR because of pathological findings in pre-participation protocol for competitive sports; the obtained results are compared with reference values derived from the literature and from a cohort of healthy volunteers studied in our centre, in order to assess the diagnostic value of strain and its possible correlations with other CMR and clinical/instrumental findings. Further analyses about the additional value of mapping techniques compared with non-parametric sequences and clinical/instrumental findings will be carried out. matherials and methods: We evaluated the first 100 competitive athletes consecutively underwent CMR in our Institute for pathological suspects. Feature tracking strain analysis was performed with Steady State Free Precession cine sequences by using a commercially available software (cvi42). Our results were compared with the reference values derived from the literature by using the same equipment and post-processing software, and with those obtained from a homogeneous population of 50 truly healthy volunteers in our Institute. Correlations between strain results and parametric/non-parametric CMR findings, and clinical/instrumental data (rest EKG, EKG stress test, 24h-Holter EKG, Sars-Cov-2 infection) were explored, considering also the type of sport activity according to COCIS classification. RESULTS: Patients included were 87 (87%) males and 13 (13%) females, mean age was 25 ± 18 years (range 12-70). Compared to literature normal values, strain parameters were normal in 69% of our population and in 65% when compared to our references. Normal GCS, according to literature values, turned out to be correlated with the absence of segmental motion abnormalities (p=0.006 and p=0.029 respectively). normal GCS according to literature values, was correlated with a normal LVEF (p=0.022). normal GRS-sax was related to normal kinesis (p=0.001). Considering reference values obtained in our centre, pathological strain values were correlated to ventricular dilation (p=0.037). Mapping analyses showed that most of the athletes had normal T1 and T2 values while pathological global ECV values correlated with the presence of focal LGE (95%, p=0.017) and that the presence of LGE correlated with pathological findings in EST (p=0.040). Moreover, when considering pathological findings in at least one ECG test, T2 mapping showed strong correlation (p=0.005 and p=0.004 respectively).

BBACKGROUND: Cardiovascular Magnetic Resonance is the primary imaging modality for the non-invasive myocardial tissue characterization, and it is considered as the gold standard technique for quantifying cardiac function, myocardial volumes and mass.Until now, most of the CMR studies in athletes have been based principally on qualitative or semiquantitative techniques for detecting oedema and/or macroscopic fibrosis by T2-weighted or late-gadolinium enhancement (LGE) sequences. Modern-day mapping techniques are significantly changing the clinical management in the patients with cardiac involvement. Moreover, in recent years, the development of feature tracking analysis has allowed a better evaluation of heart function. Thus, advanced imaging techniques are aiming to close the gaps in diagnostic accuracy in trained subjects, as there are still various uncertainties in the differential diagnosis of the athlete’s heart with other cardiac diseases. objectives: The first aim of this study is to perform strain analysis in a population of competitive athletes who underwent CMR because of pathological findings in pre-participation protocol for competitive sports; the obtained results are compared with reference values derived from the literature and from a cohort of healthy volunteers studied in our centre, in order to assess the diagnostic value of strain and its possible correlations with other CMR and clinical/instrumental findings. Further analyses about the additional value of mapping techniques compared with non-parametric sequences and clinical/instrumental findings will be carried out. matherials and methods: We evaluated the first 100 competitive athletes consecutively underwent CMR in our Institute for pathological suspects. Feature tracking strain analysis was performed with Steady State Free Precession cine sequences by using a commercially available software (cvi42). Our results were compared with the reference values derived from the literature by using the same equipment and post-processing software, and with those obtained from a homogeneous population of 50 truly healthy volunteers in our Institute. Correlations between strain results and parametric/non-parametric CMR findings, and clinical/instrumental data (rest EKG, EKG stress test, 24h-Holter EKG, Sars-Cov-2 infection) were explored, considering also the type of sport activity according to COCIS classification. RESULTS: Patients included were 87 (87%) males and 13 (13%) females, mean age was 25 ± 18 years (range 12-70). Compared to literature normal values, strain parameters were normal in 69% of our population and in 65% when compared to our references. Normal GCS, according to literature values, turned out to be correlated with the absence of segmental motion abnormalities (p=0.006 and p=0.029 respectively). normal GCS according to literature values, was correlated with a normal LVEF (p=0.022). normal GRS-sax was related to normal kinesis (p=0.001). Considering reference values obtained in our centre, pathological strain values were correlated to ventricular dilation (p=0.037). Mapping analyses showed that most of the athletes had normal T1 and T2 values while pathological global ECV values correlated with the presence of focal LGE (95%, p=0.017) and that the presence of LGE correlated with pathological findings in EST (p=0.040). Moreover, when considering pathological findings in at least one ECG test, T2 mapping showed strong correlation (p=0.005 and p=0.004 respectively).