The role of cardiac magnetic resonance imaging in sports medicine

Cardiac magnetic resonance (CMR) imaging is playing an increasingly important role in differentiating between the normal ‘athlete’s heart’, in which there is a physiological adaptation to exercise, and hereditary or congenital cardiac disease, which places the athlete at an increased risk of death during training or competition. Sudden cardiac death (SCD) in athletes is rare, affecting one in 50,000 athletes. These catastrophic events typically affect young male athletes, with black athletes eight times more susceptible than their white counterparts. Most deaths occur either during or just after exercise, with almost 80% of athletes having experienced no previous symptoms. The majority of deaths can be attributed to structural or electrical abnormalities of the heart and could have been diagnosed during life, enabling the athlete to take reasonable steps to modify their risk factors and consider withdrawing from competitive sport. Athletic adaptation to exercise is associated with several physical changes that are also observed in cardiomyopathies, providing clinicians with a unique challenge of identifying those athletes at risk of SCD while avoiding misdiagnosing healthy individuals. CMR offers us an invaluable tool for differentiating between these two groups.

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