(Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University)
Prolonged and intensive exercise induces remodeling of all four cardiac chambers,
a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation,
however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated,
arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden
cardiac death. Cardiac magnetic resonance (CMR) is a well-suited, highly reproducible
imaging modality that can help differentiate athlete’s heart from cardiomyopathy.
CMR allows accurate characterization of the morphology and function of cardiac chambers,
providing full coverage of the ventricles. Moreover, it permits an in-depth understanding
of the myocardial changes through specific techniques such as mapping or late gadolinium
enhancement. In this narrative review, we will focus on the certainties and uncertainties
of the role of CMR in sports cardiology. The main aspects of physiological adaptation
due to regular and intensive sports activity and the application of CMR in highly
trained athletes will be summarized.