News | Cardiac Imaging | January 09, 2018

Male Triathletes May Be Putting Their Heart Health at Risk

Athletes with longer cycling and swimming distances, coupled with higher peak exercise systolic blood pressure, are at higher risk of myocardial fibrosis. 

Male Triathletes May Be Putting Their Heart Health at Risk

January 9, 2018 – Competitive male triathletes face a higher risk of a potentially harmful heart condition called myocardial fibrosis, according to research presented at the annual meeting of the Radiological Society of North America (RSNA), Nov. 26-Dec. 1 in Chicago. The increased risk, which was not evident in female triathletes, was directly associated with the athletes’ amount of exercise.

Myocardial fibrosis is scarring of the heart. It usually affects the pumping chambers, also known as the ventricles. The condition might progress to heart failure. While regular exercise has beneficial effects on the cardiovascular system, previous studies have shown the presence of myocardial fibrosis in elite athletes.

“The clinical relevance of these scars is currently unclear,” said study lead author Jitka Starekova, M.D., fellow in the Department for Diagnostic and Interventional Radiology and Nuclear Medicine at University Medical Center Hamburg-Eppendorf in Hamburg, Germany. “However, they might be a foundation for future heart failure and arrhythmia.”

Starekova and colleagues recently studied a group of triathletes, including 55 men, average age 44, and 30 women, average age 43. The study group underwent cardiac magnetic resonance imaging (MRI) exams with the contrast agent gadolinium, which is taken up by both normal and injured heart muscle tissue. Gadolinium washes out quickly in normal heart tissue, but much more slowly in scarred tissue, revealing a difference in contrast between normal and injured heart muscle after approximately 10 minutes. This phenomenon, known as late gadolinium enhancement, is a useful tool for detection of myocardial fibrosis.

Evidence of myocardial fibrosis was apparent in the left ventricle — the heart’s main pumping chamber — in 10 of 55 of the men, or 18 percent, but in none of the women.

These same athletes had completed significantly longer total swimming and cycling distances and had higher peak exercise systolic blood pressure than their counterparts without myocardial fibrosis.

Lifetime competition history for the athletes showed that the number of completed Iron Man triathlons and the number of middle distance triathlons were significantly higher in the male triathlete population compared to the female triathlete population, suggesting that the fibrosis risk was likely associated with exercise level.

“Comparison of the exercise test results revealed that female triathletes had lower systolic blood pressure at peak exercise and achieved lower maximal power compared to male triathletes,” Starekova noted. “Furthermore, comparison of the sport history showed that females had a tendency to complete shorter distances compared to male triathletes. This supports the concept that blood pressure and race distances could have an impact on formation of myocardial fibrosis.”

There are several possible factors for the link between the amount of exercise and the risk of myocardial fibrosis, according to Starekova. Higher exercise-induced systolic blood pressure may result in greater myocardial mass, she said, and more exercise might expose the athlete to a higher risk of myocarditis, or inflammation of the heart muscle. These factors, in combination with repeatedly increased stress of the left ventricular wall due to exercise, could injure the heart muscle.

Other factors may be responsible for the striking difference in myocardial fibrosis risk between male and female triathletes, Starekova said, including the presence of testosterone.

“Although we cannot prove the exact mechanism for the development of myocardial fibrosis in triathletes, increased systolic blood pressure during exercise, the amount and extent of race distances and unnoticed myocarditis could be cofactors in the genesis of the condition,” she said. “In other words, repetition of any extreme athletic activity may not be beneficial for everyone.”

The researchers plan long-term follow-up studies to see if any cardiac events occur in the triathletes who had evidence of myocardial fibrosis.

Co-authors are Enver Tahir, M.D., Kai Muellerleile, M.D., Alexandra von Stritzky, M.D., Julia Muench, M.D., Maxim Avanesov, M.D., Julius Weinrich, M.D., Christian Stehning, Sebastian Bohnen, M.D., Ulf K. Radunski, M.D., Eric Freiwald, M.D., Stefan Blankenberg, M.D., Gerhard Adam, M.D., Axel Pressler, M.D., Monica Patten, M.D., and Gunnar K. Lund, M.D.

For more information: www.rsna.org 

Key RSNA 2017 Study Presentations, Trends and Video

Related Content

Philips Introduces Technology Maximizer Program for Imaging Equipment Upgrades
Technology | Imaging | January 17, 2018
January 17, 2018 — Philips recently announced the launch of Technology Maximizer, a cross-modality program designed t
Sponsored Content | Videos | Enterprise Imaging | January 17, 2018
Mitchell Goldburgh, global solutions manager for enterprise imaging and analytics manager for NTT Data Services, form
Rayence Demonstrates Full Digital Imaging Product Line at RSNA 2017
News | Digital Radiography (DR) | January 16, 2018
January 16, 2018 — Rayence recently showcased their entire line of new as well as enhanced digital imaging products a
Russian Team Developing New Technology to Significantly Reduce MRI Research Costs
News | Magnetic Resonance Imaging (MRI) | January 16, 2018
January 16, 2018 — Researchers from the NUST MISIS Engineering Center for Industrial Technologies in Russia have deve
Sponsored Content | Videos | Enterprise Imaging | January 16, 2018
Built on an over 25-year pioneering legacy in the advanced visualization industry, Vital continues to expand on three
RSNA 2017 Celebrates Innovation in Radiology
News | Imaging | January 15, 2018
January 15, 2018 — The Radiological Society of North America’s...
Transpara Deep Learning Software Matches Experienced Radiologists in Mammogram Reading
News | Computer-Aided Detection Software | January 12, 2018
Deep learning and artificial intelligence improves the efficiency and accuracy of reading mammograms, according to...
Smartphone Addiction Creates Imbalance in Brain
News | Mobile Devices | January 11, 2018
Researchers have found an imbalance in the brain chemistry of young people addicted to smartphones and the internet,...
Fat Distribution in Women and Men Provides Clues to Heart Attack Risk
News | Women's Health | January 11, 2018
January 11, 2018 – It’s not the amount of fat in your body but where it is stored that may increase your risk for hea
Minimally Invasive Treatment Provides Relief from Back Pain

Lumbar spine MRI showing disc herniation and nerve root at baseline and one month after treatment

News | Interventional Radiology | January 11, 2018
The majority of patients were pain free after receiving a new image-guided pulsed radiofrequency treatment for low back...
Overlay Init