Hyper-trabeculation in olympic athletes: advanced LV function analysis by CMR

Background Left ventricular (LV) hyper-trabeculation is frequently observed among high-level athletes and often raises concerns for differential diagnosis with cardiomyopathies. Aim To evaluate standard and advanced LV function by CMR in a cohort of elite athletes with LV hyper-trabeculation. Methods Thirty Olympic athletes with LV hyper-trabeculation and thirty without LV hyper-trabeculation matched for sex (59% male) and sport disciplines (power 24%, mixed 28% and endurance 48%) were enrolled. They all underwent cardiovascular preparticipation screening that was unremarkable. CMR without contrast administration was performed. Hyper-trabeculation was defined based on Petersen criteria for left ventricular non-compaction (LVNC), but all the athletes presented preserved compacted layer. Differences in standard and advanced LV function parameters between the two groups were evaluated using a dedicated, offline feature-tracking software to analyze the standard three long-axis cine loops. LV global longitudinal and circumferential strain (GLS and GCS) and LV hemodynamic forces (HDFs), representing the forces exchanged between the blood and the myocardium and being novel and validated markers of LV function were evaluated. The ratio between the HDFs two main directions (longitudinal and transversal), meaning the distribution of forces into the LV, was computed in the entire cardiac cycle, systole and diastole. Results There were no significant differences between the two groups regarding the amount of training in terms of years and hours of training per week (p=0.065 and p=0.262, respectively). Hyper-trabeculated athletes showed slightly higher LV volumes and lower ejection fraction than non-hyper-trabeculated ones, even if the difference was not statistically significant (EDVi, ESVi and EF: p= 0.397, 0.118 and 0.101, respectively). There were also no significant differences in LV-GLS, GCS and HDFs distribution in the entire cardiac cycle, systole and diastole (Table and Figure). Conclusions Olympic athletes with LV hyper-trabeculation but preserved compacted layer did not significantly differ from non-hypertrabeculated ones in terms of dimension and advanced parameters of LV function. CMR advanced study of LV function could help differentiate physiological and pathological remodelling in athletes.