Table 1.

Recent studies indicating prevalence and patterns of myocardial fibrosis in athletic populations using CMR

Study	Size	Exercise type	Age	Pattern	Prevalence	Associated factors
Merghani [45•]	n = 152	Masters endurance athletes	54.4 ± 9 years	7% Ischemic pattern 8% non-ischemic pattern	14% male athletes	No relationship between fibrosis and exercise intensity, years of training, or number of competitions
Breuckmann [46]	n = 102	‘Ostensibly’ healthy male runners	61 ± 11 years	5% ischemic pattern 7% non-ischemic pattern	12% prevalence	The event-free survival rate was lower in runners with myocardial LGE than in those without myocardial LGE
Tahir et al.[47••]	n = 83	Triathletes	43 ± 10 years	Focal non-ischemic myocardial	17% male athletes	Exercise-induced hypertension and the race distances
Sanchis-Gomar [48]	n = 53	11 former ‘elite’ and 42 amateur-level cyclists or runners	55 ± 15 years	Non-ischemic pattern	4% former ‘elite’	No association with any of the biomarkers of fibrosis/remodeling
Wilson [49]	n = 12	Competitive endurance veteran athletes	56 ± 6 years	4 veteran athletes with nonspecific cause 1 previous myocarditis 1 silent myocardial infarction	50% of veteran athletes	Number of years spent training, number of competitive marathons and ultra-marathons completed
Schnell [50]	n = 7	Asymptomatic athletes recruited during workup of abnormalities on their regular screening examination	26 ± 5 years	Extensive subepicardial LGE predominantly in the lateral wall	100% prevalence as per inclusion criteria	Symptomatic ventricular tachycardia and progressive left ventricular dysfunction

LGE late gadolinium enhancement