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

Turkish Hospital Begins MR-Guided Radiation Therapy With Viewray MRIdian Linac
News | Image Guided Radiation Therapy (IGRT) | September 21, 2018
ViewRay Inc. announced that Acibadem Maslak Hospital in Istanbul, Turkey has begun treating patients with ViewRay's...
Philips Showcases Integrated Solutions for Cardiovascular Care at TCT 2018
News | Cardiac Imaging | September 20, 2018
At the Transcatheter Cardiovascular Therapeutics (TCT) annual meeting, Sept. 21–25 in San Diego, Philips is showcasing...
Machine Learning IDs Markers to Help Predict Alzheimer's

Neurologists use structural and diffusion magnetic resonance imaging (MRI) to identify changes in brain tissue (both gray and white matter) that are characteristic of Alzheimer's disease and other forms of dementia. The MRI images are analyzed using morphometry and tractography techniques, which detect changes in the shape and dimensions of the brain and in the tissue microstructure, respectively. In this example, the images show the normal brain of an elderly patient. Image courtesy of Jiook Cha.

News | Neuro Imaging | September 20, 2018
New research has shown a combination of two different modes of magnetic resonance imaging (MRI), computer-based...
LVivo EF Cardiac Tool Now Available for GE Vscan Extend Handheld Mobile Ultrasound
Technology | Cardiovascular Ultrasound | September 19, 2018
DiA Imaging Analysis Ltd. (DiA), a provider of artificial intelligence (AI)-powered ultrasound analysis tools,...
Siemens Healthineers Announces First U.S. Install of Somatom go.Top CT
News | Computed Tomography (CT) | September 17, 2018
September 17, 2018 — The Ohio State University Wexner Medical Center in Columbus recently became the first healthcare
Ingenia Ambition X 1.5T MR. This innovation is the latest advance in the Ingenia MRI portfolio, which comprises fully-digital MRI systems, healthcare informatics and a range of maintenance and life cycle services for integrated solutions that empower a faster, smarter, and simpler path to enabling a confident diagnosis
News | Magnetic Resonance Imaging (MRI) | September 14, 2018
Philips, a global leader in health technology, launched the Ingenia Ambition X 1.5T MR.
Gadolinium contrast agents (GBCAs) are partly retained in the brain, raising safety concerns, as seen in this MRI.

Gadolinium contrast agents (GBCAs) are partly retained in the brain, raising safety concerns, as seen in this MRI.

News | Contrast Media | September 12, 2018
In February 2018, a workshop was held at the National Institutes of Health (NIH) in Bethesda, Maryland, to explore co
Veye Chest version 2
News | Lung Cancer | September 11, 2018
Aidence, an Amsterdam-based medical AI company, announced that Veye Chest version 2, a class IIa medical device, has
Sponsored Content | Case Study | Magnetic Resonance Imaging (MRI) | September 07, 2018 | By Sabine Sartoretti, M.D.
As soon as the Compressed SENSE technology became available to the MRI team at Kantonsspital Winterthur (Switzerland),...
The Siemens Biograph Vision PET-CT system was released in mid-2018.

The Siemens Biograph Vision PET-CT system was released in mid-2018.

Feature | Nuclear Imaging | September 07, 2018 | By Dave Fornell
Nuclear imaging technology for both single photon emission computed tomography (SPECT) and positron emission tomography...