Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes.

Wilson MG, O'Hanlon R, Prasad S, Deighan A, Macmillan P, Oxborough D, Godfrey RJ, Smith G, Maceira A, Sharma S, George KP, Whyte G. 

1ASPETAR- Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. 

Abstract 

Aims - This study examined the cardiac structure and function of a unique cohort of documented life-long, competitive endurance veteran athletes (> 50 years).  

Methods and Results - Twelve lifelong veteran male endurance athletes (mean ± SD [range] age: 56 ± 6 yr [50-67]), 20 age-matched veteran controls (60 ± 5 y; [52 - 69]) and 17 younger male endurance athletes (31 ± 5 years [26-40]) without significant co-morbidities underwent cardiac magnetic resonance (CMR) imaging to assess cardiac morphology and function, with CMR imaging with late gadolinium enhancement (LGE) to assess myocardial fibrosis.  

Results - Lifelong veteran athletes had smaller LV and RV end-diastolic and end-systolic volumes (p<0.05) but maintained LV and RV systolic function compared to young athletes. However, veteran athletes had a significantly larger absolute and indexed LV and RV end-diastolic and systolic volumes, intra-ventricular septum thickness during diastole, posterior wall thickness during diastole, and LV and RV stroke volumes (p<0.05), together with significantly reduced LV and RV ejection fractions (p<0.05) compared to veteran controls. In 6 (50%) of the veteran athletes LGE of CMR indicated the presence of myocardial fibrosis (4 veteran athletes with LGE of non-specific cause, 1 probable previous myocarditis and 1 probable previous silent myocardial infarction). There was no LGE in the veteran controls or young athletes. The prevalence of LGE in veteran athletes was not associated with age, height, weight or BSA (p>0.05), but was significantly associated with the number of years spent training (p<0.001), number of competitive marathons (p<0.001) and ultra-endurance (>50 miles) marathons (p<0.007) completed.  

Conclusion - An unexpectedly high prevalence (50%) of myocardial fibrosis was observed in healthy, asymptomatic life-long veteran male athletes, compared to zero cases in age-matched veteran controls and young athletes. This data suggests a link between life-long endurance exercise and myocardial fibrosis that requires further investigation. 

PMID: 21330616 [PubMed - as supplied by publisher]

Journal of Applied Physiology 2011 Feb 17. [Epub ahead of print]