Athlete status and gender strongly influence CMR T1 mapping times: an athlete-control study

Abstract

Abstract Background/Introduction In the general population, cardiac magnetic resonance imaging (CMR) T1 mapping is an established tool used for cardiac tissue characterisation. Such characterisation is of particular interest in athletes, as differentiation of the “grey zone” between physiological adaptation to sports and myocardial pathology can be highly challenging. To correctly interpret individual T1 times, T1 times are conventionally compared with normal values derived from healthy controls. However, whether these normative T1 values can be applied to elite athletes, who commonly demonstrate the most extreme cardiac adaptation, is unknown. Purpose To determine whether there are gender-specific differences in normative T1 times between elite athletes and healthy controls. Methods This study is a cross-sectional assessment of healthy athletes included the ELITE-cohort. ELITE includes athletes at national, international, and Olympic level in the Netherlands, aged sixteen years or older and without a history of cardiovascular disease. All athletes undergo standard periodic preparticipation screening with cardiovascular magnetic resonance imaging (Phillips 1.5 Tesla), including native T1 mapping. For the current study, we compared athletes to healthy controls per gender group. T1 inversion times were calculated in Circle Cardiovascular software (v5.12); means for global and segmented myocardium, according to the AHA 16-segment model, were determined using R (v4.1.4). Results A total of 81 elite athletes (35 women, 43.2%) with a median (IQR) age of 26 (22.0–29.55) years and 55 healthy controls (27 women, 49.1%), with a mean age of 38.4±15 years were included (Table 1). Overall, mean global T1 times were markedly shorter in athletes compared with controls (959±21.1ms vs. 984±26.6ms, P<0.001). This difference was also present in both women (athletes 968±18.5ms vs controls 999±26.5ms, P<0.001) and men (athletes 952±20.3ms vs controls 970±18.0ms, P<0.001). We observed gender differences in T1 times within both the athlete (men 952±20.3ms vs women 968±18.5ms, P<0.001) and the control group (men 984±26.6ms vs women 999±26.5ms, P<0.001). Gender specific differences in T1 times were consistent between athletes and controls in the basal-, mid- and apical slices, as well as across all 16 segments (Figure panels A and B). Conclusion(s) Athletes demonstrate markedly shorter T1 times as compared with healthy controls, both in women and men. Sex-specific, athlete-normative T1 times should be taken into account when interpreting T1 times in athletes undergoing cardiac evaluation. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Amsterdam Movement Sciences and the Dutch Olympic Committee*Dutch Sports Federation