Left ventricular diastolic filling patterns in competitive triathletes with and without myocardial fibrosis by cardiac magnetic resonance time-volume analysis

PURPOSE: To investigate the influence of myocardial fibrosis on left ventricular (LV) diastolic filling patterns in triathletes compared to sedentary controls by cardiac magnetic resonance (CMR) imaging.

METHOD: 101 male triathletes (43 ± 11 years) and 28 controls (41 ± 10 years) were recruited and underwent 1.5 T CMR including cine SSFP series, late gadolinium enhancement (LGE) imaging and T1 mapping. Functional and morphological parameters were obtained, and CMR-based LV diastolic filling parameters such as the early peak-filling rate (EPFR), atrial peak-filling rate (APFR) and peak-filling rate ratio (PFRR = EPFR/APFR) were determined by time-volume analysis of the cine series.

RESULTS: Non-ischemic LGE was detected in 20 triathletes (20 %) and in none of the controls. Compared to controls LGE-negative (LGE-) triathletes showed similar EPFR (216 ± 58 ml/s/m2 vs 224 ± 69 ml/s/m2, P = 0.52) but lower APFR (120 ± 46 ml/s/m2 vs 147 ± 55 ml/s/m2, P < 0.05), resulting in higher PFRR (2.1 ± 1 vs 1.6 ± 0.5, P < 0.01). LGE-positive (LGE + ) triathletes had similar EPFR (212 ± 73 ml/s/m2, P = 0.798), but higher APFR (149 ± 50 ml/s/m2, P < 0.05) and decreased PFRR (1.6 ± 0.7, P < 0.05) compared to LGE- triathletes. LGE + triathletes had increased LV mass index (88 ± 10 g/m2 vs 80 ± 12 g/m2, P < 0.01) and extracellular volume (ECV) fraction (26.2 ± 2.7 % vs 24.4 ± 1.7 %, P < 0.001) compared to LGE- triathletes.

CONCLUSIONS: Athletic activity leads to "supernormal" LV diastolic filling pattern in LGE- triathletes, which may be attributable to increased LV myocardial flexibility and elasticity. However, LGE + triathletes demonstrate a pseudo-normalization characterized by compensatory increase of atrial contraction. Possibly, due to reduced passive elasticity associated myocardial fibrosis.