PhD Scientific Days 2025

Poster Session II. - U: Cardiovascular Medicine and Research

Athlete's heart vs. cardiomyopathy: the role of cardiac magnetic resonance imaging

Name of the presenter

Balla Dorottya

Institute/workplace of the presenter

Heart and Vascular Center, Semmelweis University

Authors

Dr. Dorottya Balla¹

1: Heart and Vascular Center, Semmelweis University

Text of the abstract

Introduction: Sudden cardiac death (SCD) in young athletes is often associated with structural myocardial diseases. Cardiac magnetic resonance imaging (CMR) is an advanced imaging modality that plays a key role in detecting myocardial tissue abnormalities.

Aims: To investigate the prevalence of structural myocardial diseases and the etiology of SCD in athletes.

Methods: We included athletes (≥6 hours of training per week) who underwent CMR due to suspected structural myocardial disease in our Center. In cases of confirmed myocardial disease or after resuscitation/sustained ventricular tachycardia, genetic testing was also performed.

Results: A total of 687 athletes (541 males, mean age: 24.2±10.9 years) were examined. Indications for CMR included resuscitation/sustained ventricular tachycardia (4%), abnormal ECG findings (47%), echocardiographic abnormalities (17%), positive family history (10%), and cardiac symptoms (23%). Structural myocardial abnormalities were identified in 120 athletes (103 males, mean age: 31.6±13.5 years, weekly training: 11.3±5.5 hours). Among cardiomyopathies, hypertrophic cardiomyopathy (HCM) was diagnosed in 39 cases, arrhythmogenic cardiomyopathy (AC) in 14, and dilated cardiomyopathy (DCM) in 11 athletes. Non-ischemic fibrosis/scarring was detected in 36 athletes, including cases of prior myocarditis and atypical patterns. Among athletes investigated after resuscitation or sustained ventricular tachycardia, 15 had identifiable abnormalities: AC (7 cases), HCM (1 case), mitral annular disjunction (MAD) (1 case), ischemic damage (2 cases), and atypical fibrosis (4 cases). Genetic testing was performed in 41 athletes, revealing pathogenic or likely pathogenic mutations in 12 cases and variants of uncertain significance in 18 cases.

Conclusions: In this large-scale study of athletes, HCM was the most frequently identified cardiomyopathy, whereas AC was the most common underlying cause of SCD. CMR and genetic testing play a crucial role in clarifying the etiology of sudden cardiac death in young athletes.

Funding: TKP2021-NKTA-46, SUPPORTED BY THE EKÖP-2024-165 NEW NATIONAL EXCELLENCE PROGRAM OF THE MINISTRY FOR CULTURE AND INNOVATION FROM THE SOURCE OF THE NATIONAL RESEARCH, DEVELOPMENT AND INNOVATION FUND