Exercise-induced myocardial edema in master triathletes: Insights from cardiovascular magnetic resonance imaging

Fabrizio Ricci; Giovanni Donato Aquaro; Carlo De Innocentiis; Serena Rossi; Cesare Mantini; Francesca Longo; Mohammed Y Khanji; Sabina Gallina; Alessandro Pingitore

doi:10.3389/fcvm.2022.908619

Exercise-induced myocardial edema in master triathletes: Insights from cardiovascular magnetic resonance imaging

Front Cardiovasc Med. 2022 Aug 2:9:908619. doi: 10.3389/fcvm.2022.908619. eCollection 2022.

Authors

Affiliations

¹ Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
² Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden.
³ MRI Laboratory, Fondazione Toscana G. Monasterio, Pisa, Italy.
⁴ Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy.
⁵ University of Trieste, Trieste, Italy.
⁶ Newham University Hospital, Barts Health NHS Trust, London, United Kingdom.
⁷ William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.
⁸ Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
⁹ Clinical Physiology Institute, CNR, Pisa, Italy.

Abstract

Background: Strenuous exercise has been associated with functional and structural cardiac changes due to local and systemic inflammatory responses, reflecting oxidative, metabolic, hormonal, and thermal stress, even in healthy individuals. We aimed to assess changes in myocardial structure and function using cardiovascular magnetic resonance (CMR) imaging in master triathletes early after a full-distance Ironman Triathlon race.

Materials and methods: Ten master triathletes (age 45 ± 8 years) underwent CMR within 3 h after a full-distance Ironman Triathlon race (3.8 km swimming, 180 km cycling, and 42.2 km running) completed with a mean time of 12 ± 1 h. All the triathletes had a 30-day follow-up CMR. Cine balanced steady-state free precession, T2-short tau inversion recovery (STIR), tagging, and late gadolinium enhancement (LGE) imaging sequences were performed on a 1.5-T MR scanner. Myocardial edema was defined as a region with increased T2 signal intensity (SI) of at least two SDs above the mean of the normal myocardium. The extent of myocardial edema was expressed as the percentage of left ventricular (LV) mass. Analysis of LV strain and torsion by tissue tagging included the assessment of radial, longitudinal, and circumferential peak systolic strain, rotation, and twist.

Results: Compared with postrace, biventricular volumes, ejection fraction, and LV mass index remained unchanged at 30-day follow-up. Global T2 SI was significantly higher in the postrace CMR (postrace 10.5 ± 6% vs. follow-up 3.9 ± 3.8%, P = 0.004) and presented with a relative apical sparing distribution (P < 0.001) matched by reduction of radial peak systolic strain of basal segments (P = 0.003). Apical rotation and twist were significantly higher immediately after the competition compared with follow-up (P < 0.05).

Conclusion: Strenuous exercise in master triathletes is associated with a reversible regional increase in myocardial edema and reduction of radial peak systolic strain, both presenting with a relative apical sparing pattern.

Keywords: CMR; Ironman; athlete’s heart; deformation imaging; master triathletes.