Myocardial fibrosis and its relationship with ventricular arrhythmias and reduced ventricular systolic function in young and veteran endurance athletes
Year: 2025
Type: article
Study design: Observational Study
Abstract: AIMS: The prevalence of ventricular fibrosis and its association with ventricular arrhythmias (VAs) and reduced ventricular systolic function in endurance athletes remains unclear. METHODS AND RESULTS: We evaluated 296 young [median age 19 (17-22)] and 138 middle-aged [56 (50-60)] male endurance athletes, alongside 66 middle-aged non-athletic controls [54 (49-60)], all without known cardiac disease. Cardiac magnetic resonance imaging assessed myocardial fibrosis and biventricular function. Twenty-four-hour Holter monitoring was used to quantify VAs. Non-hinge-point fibrosis was more prevalent in middle-aged athletes compared with young athletes (20 vs. 3%, P < 0.001) and middle-aged controls (20 vs. 9%, P = 0.045), while hinge-point fibrosis did not differ. Reduced left ventricular ejection fraction and/or right ventricular ejection fraction was more frequent in middle-aged athletes than controls (23 vs. 8%, P = 0.009), but similar to young athletes (23 vs. 22%, P = 0.906). Middle-aged athletes had a higher prevalence of non-sustained ventricular tachycardia (8 vs. 2%, P = 0.006), >100 premature ventricular complexes/24 h (13 vs. 5%, P = 0.004), multifocal ventricular ectopy (11 vs. 4%, P = 0.003), and complex ventricular ectopy (25 vs. 10%, P < 0.001) compared with young athletes, with no significant differences compared with controls. Non-hinge-point fibrosis increased the odds of a higher burden of unifocal and multifocal ventricular ectopy, but not of reduced systolic function. CONCLUSION: Middle-aged athletes more frequently exhibit myocardial fibrosis than young athletes and middle-aged non-athletes. Non-hinge-point fibrosis is present in up to one-fifth of middle-aged athletes and predictive of a higher burden of both unifocal and multifocal ventricular ectopy. Reduced systolic function is more prevalent in athletes and not predicted by fibrosis. LAY SUMMARY: We studied young and middle-aged male endurance athletes and non-athletes using heart magnetic resonance imaging scans and 24 h heart rhythm monitoring to evaluate scarring of the heart muscle, pumping function, and abnormal heart rhythms.Scarring of the heart muscle is relatively common in middle-aged athletes, but rare in the young. About one in five middle-aged athletes showed a particular 'non-hinge-point' pattern of scar tissue, which was rare in young athletes and also less frequent in middle-aged non-athletic individuals.Non-hinge-point scar was linked with more frequent abnormal heart rhythms. Athletes with this pattern of scar more frequently had premature ventricular beats (extra beats originating from the heart's lower chambers).
Authors: Jarne De Paepe, Paolo D’Ambrosio, Ruben De Bosscher, Youri Bekhuis, Rik Pauwels, Christophe Dausin, Kristel Janssens, Amy Mitchell, Adrian Elliott, Caroline M Van De Heyning, Prashanthan Sanders, Peter M Kistler, Jonathan M Kalman, Diane Fatkin, Hein Heidbuchel, Lieven Herbots, Rik Willems, Tomas Robyns, Olivier Ghekiere, Jan Bogaert, André La Gerche, Guido Claessen, Sofie Van Soest, Piet Claus, Peter Sinnaeve, Mathias Claeys, Kaatje Goetschalckx, Tim Van Puyvelde, Bert Vandenberk, Peter Hespel, Steven Dymarkowski, Tom Dresselaers, Boris Delpire, Hielko Miljoen, Kasper Favere, Bernard Paelinck, Dorien Vermeulen, Isabel Witvrouwen, Dominique Hansen, Bert Op't Eijnde, Daisy Thijs, Peter Vanvoorden, Kristof Lefebvre, Stephanie Rowe, Luke Spencer, Elizabeth Paratz, Maria J Brosnan, David L Prior
Institutions: Universitair Ziekenhuis Leuven, KU Leuven, The Royal Melbourne Hospital, The University of Melbourne, Jessa Hospital, Hartcentrum Hasselt, Hasselt University, UNSW Sydney, Royal Adelaide Hospital, The University of Adelaide, University of Antwerp, Antwerp University Hospital, Baker Heart and Diabetes Institute, The Alfred Hospital, Monash University, Victor Chang Cardiac Research Institute, St Vincent's Hospital Sydney
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Fonds Wetenschappelijk Onderzoek
OpenAlex ID: W4417477879