Myocardial fibrosis in Athletes: Long term implication on myocardial function? A cardiac magnetic imaging study (MOVE-Study)

• Applicants: Professor Dr. Gunnar Lund; Professor Dr. Götz Hannes Welsch
• Subject Area: Cardiology, Angiology ; Radiology
• Term: since 2026
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 575732625

Moderate regular exercise has beneficial effects on the cardiovascular system and regular activity is recommended for primary and secondary prevention of cardiovascular diseases. On the other hand, exercise is also associated with sudden cardiac death during or immediately after physical exertion in a small minority of athletes. Currently, it is unclear whether there is a safe upper limit beyond which the potential negative effects of exercise may outweigh its benefits. We previously showed, that athletes with focal nonischemic myocardial fibrosis (LGE+) had higher peak exercise systolic blood pressure compared to LGE- triathletes. Furthermore, left ventricular mass index was higher in LGE+ triathletes compared to LGE- triathletes. Multivariate analysis identified peak exercise systolic blood pressure and the swimming race distance as independent predictors of LGE in triathletes. Our data suggested that presence of LGE is correlated with increased blood pressure under exercise and with the absolved swimming distance during competition. Furthermore, we showed that LGE+ triathletes have reduced systolic function obtained by CMR feature tracking strain analysis. We showed that global radial strain was lower in LGE+ triathletes with 40 +-7% compared with LGE- athletes (45 +-7%, P<0.05), whereas LV ejection fraction was normal in LGE+ (62 +-6%) and LGE- triathletes (62 +-5%, P<0.958). Our data lead to the hypothesis that a repetitive volume overload of the myocardium induced by intensive endurance training sessions of several hours per day over many years may have an impact on myocardial physiological adaptation as well as pathological remodeling, resulting in a consecutive pressure overload with increased blood pressures during exercise and LGE development in athletes. In the last years we studied a total of 320 athletes using contrast enhanced cardiac magnetic resonance imaging (CMR) and spiroergometry including 160 triathletes, 80 marathon runners and 80 bicycle riders. The planed follow-up study will analyze several two questions of the currently existing studies: First, how many athletes develop a new LGE in those athletes which initially had no LGE on CMR? Second, how is the development of LGE size in athletes with existing LGE? Is there an increase in size in athletes who regularly participate in competitions or does the LGE size remains constant over time? The question is, whether myocardial fibrosis is a continuous process in athletes with new areas of fibrosis over time and how frequent new fibrosis occurs? Furthermore, the increase in fibrosis size is important since the size of LGE has prognostic implications in athletes. We recently showed, that athletes with an LGE size of >5% LV area are at increased risk for sudden cardiac death.

• DFG Programme: Research Grants