Myocardial fibrosis is a prevalent finding in elite high-endurance athletes
Bibliographic record
Abstract
Autopsies in athletes have shown that athletes have diffuse myocardial fibrosis, and epidemiological findings place athletes at a greater relative risk of sudden death due to cardiovascular causes. Electrocardiography abnormalities are well documented in athletes, where it is widely accepted that these are characteristic of the 'athlete's heart'. Furthermore, biochemical markers of collagen breakdown and myocardial fibrosis are elevated in athletes. As such, using CMR late Gadolinium enhancement (LE) imaging, we hypothesized that fibrosis is a feature of the athlete's heart and is associated with reduced cardiac function. 48 elite athletes (25 male, age 32 ± 13 years), and a control group of 8 healthy individuals (4 male, 31 ± 9 years) were prospectively recruited. On a 1.5 T MRI system, standard protocols for assessment for LV function and T1-weighted LE were performed. Two experienced observers assessed LE images visually for the presence of fibrosis. The extent of fibrosis was assessed quantitatively, using semi-automated detection where regions that had signal enhancement above a threshold of 5 standard deviations from the mean signal of healthy myocardium, were considered to represent fibrosis. Areas that had a lack of contrast enhancement were used to define healthy myocardium. Abbreviations utilized: LVEDVI – LV end-diastolic volume indexed-to-height; LVESVI – LV end-systolic volume indexed-to-height; LVSVI – LV stroke volume indexed-to-height; LVEF – LV ejection fraction 37 of 48 (77%) athletes had non-ischemic diffuse LE, compared with 1 of 8 (13%) of controls. The extent of myocardial fibrosis in athletes who had visual evidence for LE was 10.7 ± 3.3%. Athletes with fibrosis had increased LVEDVI (117 ± 19 vs. 98 ± 15 ml/m, p < 0.05), LVESVI (44 ± 11 vs. 34 ± 10 ml/m, p < 0.05), and LVSVI (73 ± 11 vs. 64 ± 7 ml/m, p < 0.05), while LVEF (63 ± 5 vs. 66 ± 6%, p > 0.05) did not differ, when compared to those who did not have fibrosis. Figure 1 . T1-weighted late gadolinium enhancement images . Left panels : Evidence of subepicardial non-ischemic myocardial fibrosis in athletes 1 and 2 (arrows), with none in healthy control. Right panels : Quantification of myocardial fibrosis by manually tracing a region of interest in health remote myocardium (blue outline). Automated computer thresholding set at 5 standard deviations above the mean signal intensity of remote myocardium detects fibrosis (red overlay). The detected extent of fibrosis for athlete 1 is 14.12%, 11.30% for athlete 2 and 0.20% for control. This is the first evidence of myocardial fibrosis being a prevalent finding in elite athletes, and its relation to cardiac morphology with depressed cardiac function. Long-term follow-up is required to assess the impact of fibrosis on outcome and prognosis in the 'athlete's heart'.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".