Background: Cardiovascular magnetic resonance (CMR) imaging, utilising native T1 and T2 mapping, provides a non-invasive method for assessing myocardial tissue properties, contributing to the clinical evaluation of the athlete's heart. Objective: To evaluate T1 and T2 mapping alterations and their association with sex, training volume, sports type, and other standard CMR parameters of the athlete's heart. Methods: We conducted a cross-sectional analysis of healthy elite athletes (≥10 training hours/week) and sedentary controls (≤5 h/week) who underwent detailed cardiology screening. CMR was performed, and native T1 and T2 values were quantified. Results: Of the 199 healthy participants (115 elite athletes, 24 ± 5 years, 70 % males; 84 sedentary volunteers, 26 ± 3 years, 58 % males), athletes had higher ventricular volumes, left ventricular mass (LVMi), and lower ejection fractions than volunteers. Athletes showed lower T1 values (male athletes:941 ± 23 ms vs. 960 ± 21 ms, p < 0.01; female athletes:970 ± 20 ms vs. 982 ± 25 ms, p < 0.01). T1 negatively correlated with training hours and LVMi (Rho: −0.554, p < 0.001). T1 values were positively associated with female sex with 22 ms (CI 14.3, 29.7, p < 0.001) higher values than males, while each additional hour in weekly exercise volume was associated with a 0.5 ms (CI -0.84, −0.11, p = 0.011) decrease. Compared to strength and mixed athletes, endurance athletes showed more pronounced myocardial adaptation, reflected in lower T1. Conclusion: Sex, training volume, and type of sport significantly influence CMR-derived T1 and T2 values. This study highlights the critical need for sex- and sport-type-specific reference ranges in assessing myocardial remodelling in athletes, facilitating the distinction between benign athletic remodelling and (early) pathological changes.
The role of sex, training load, and sports type in athletic cardiac remodelling: Insights from T1 and T2 mapping via cardiac magnetic resonance
Graziano, Francesca;
2025
Abstract
Background: Cardiovascular magnetic resonance (CMR) imaging, utilising native T1 and T2 mapping, provides a non-invasive method for assessing myocardial tissue properties, contributing to the clinical evaluation of the athlete's heart. Objective: To evaluate T1 and T2 mapping alterations and their association with sex, training volume, sports type, and other standard CMR parameters of the athlete's heart. Methods: We conducted a cross-sectional analysis of healthy elite athletes (≥10 training hours/week) and sedentary controls (≤5 h/week) who underwent detailed cardiology screening. CMR was performed, and native T1 and T2 values were quantified. Results: Of the 199 healthy participants (115 elite athletes, 24 ± 5 years, 70 % males; 84 sedentary volunteers, 26 ± 3 years, 58 % males), athletes had higher ventricular volumes, left ventricular mass (LVMi), and lower ejection fractions than volunteers. Athletes showed lower T1 values (male athletes:941 ± 23 ms vs. 960 ± 21 ms, p < 0.01; female athletes:970 ± 20 ms vs. 982 ± 25 ms, p < 0.01). T1 negatively correlated with training hours and LVMi (Rho: −0.554, p < 0.001). T1 values were positively associated with female sex with 22 ms (CI 14.3, 29.7, p < 0.001) higher values than males, while each additional hour in weekly exercise volume was associated with a 0.5 ms (CI -0.84, −0.11, p = 0.011) decrease. Compared to strength and mixed athletes, endurance athletes showed more pronounced myocardial adaptation, reflected in lower T1. Conclusion: Sex, training volume, and type of sport significantly influence CMR-derived T1 and T2 values. This study highlights the critical need for sex- and sport-type-specific reference ranges in assessing myocardial remodelling in athletes, facilitating the distinction between benign athletic remodelling and (early) pathological changes.
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