Key result
CMR early gadolinium enhancement is linked to ~589% higher odds of ventricular rhythm disturbances in athletes.
Why the study?
The exact role and additive value of cardiovascular magnetic resonance during pre-participation sports examination in adolescent athletes with ventricular rhythm disturbances remained undefined.
Does cardiovascular magnetic resonance (CMR) identify arrhythmogenic substrates in asymptomatic young athletes with ventricular rhythm disturbances and normal echocardiography?
Case-Control (n=70)
No
Does cardiovascular magnetic resonance (CMR) identify arrhythmogenic substrates in asymptomatic young athletes with ventricular rhythm disturbances and normal echocardiography?
CMR provides significant additive value by identifying underlying arrhythmogenic substrates, such as myocarditis and ARVC, in asymptomatic young athletes with ventricular arrhythmias but normal standard evaluations.
CMR may detect occult arrhythmogenic substrates in athletes with ventricular arrhythmias; leaves open whether screening alters management or outcomes.
Pre-participation sports examination (PPE) is a frequent reason for consultation. However, the exact role of cardiovascular magnetic resonance (CMR) in PPE remains undefined. The additive value of CMR in adolescent athletes with ventricular rhythm disturbances (VRDs) was investigated. We prospectively recruited and evaluated with CMR 50 consecutive, asymptomatic young athletes referred to our tertiary center after identification of VRDs on electrocardiogram (ECG) with otherwise normal standard PPE and echocardiography, and 20 age- and sex-matched healthy volunteer athletes who underwent the same evaluations. The primary outcome was case-control status and the secondary outcome was the discrimination between athletes with VRDs with and without non-sustained ventricular tachycardia (VT). CMR identified arrhythmogenic substrates in all athletes with VRDs. The predominant condition was myocarditis and arrhythmogenic right ventricular cardiomyopathy in patients with and without VT, respectively. Based on penalized regression analysis, late gadolinium enhancement (LGE), early gadolinium enhancement (EGE), extracellular volume fraction (ECV), and T2-mapping, best distinguished between case-control status. The aforementioned indices predicted case-control status independent of age and sex: EGE [Odds ratio (95% confidence interval): 6.89 (2.19-21.62) per 0.5-unit, P<0.001], LGE (perfect prediction), ECV [1.66 (1.25-2.22), P<0.001] and T2 mapping [1.40 (1.13-1.72), P=0.002], among other independent CMR-derived predictors. Only indexed ventricular volumes independently discriminated between VRD patients with and without VT. In this study, asymptomatic young athletes with VRDs and normal PPE/echocardiography were optimally discriminated from healthy control athletes by CMR-derived indices, and CMR allowed for the identification of arrhythmogenic substrates in all cases.
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Markousis‐Mavrogenis et al. (2020) conducted a case-control in Ventricular rhythm disturbances (n=70). Cardiovascular magnetic resonance (CMR) indices vs. Healthy control athletes was evaluated on Case-control status (discrimination between athletes with VRDs and healthy controls) (OR 6.89, 95% CI 2.19-21.62, p=<0.001). Cardiovascular magnetic resonance-derived indices, particularly early gadolinium enhancement (OR 6.89), late gadolinium enhancement, extracellular volume, and T2-mapping, optimally discriminated asymptomatic young athletes with ventricular rhythm disturbances from healthy controls.
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