PURPOSE: Sudden cardiac death [SCD] in competitive athletes is caused by a 
diverse set of cardiovascular diseases such as hypertrophic and dilated 
cardiomyopathy [HCM/DCM], myocarditis, coronary anomalies or even coronary 
artery disease. In order to identify potential risk factors responsible for SCD, 
elite athletes underwent cardiac magnetic resonance [CMR] imaging.
MATERIALS AND METHODS: 73 male [M] and 22 female [F] athletes (mean age 
35.2 ± 11.4 years) underwent CMR imaging. ECG-gated breath-hold cine SSFP 
sequences were used for the evaluation of wall motion abnormalities and 
myocardial hypertrophy as well as for quantitative analysis (left and right 
ventricular [LV, RV] end-diastolic and end-systolic volume [EDV, ESV], stroke 
volume [SV], ejection fraction [EF] and myocardial mass [MM]). Furthermore, left 
and right atrial sizes were assessed by planimetry and delayed enhancement 
imaging was performed 10 minutes after the application of contrast agent. 
Coronary arteries were depicted using free-breathing Flash-3 D MR angiography.
RESULTS: The quantitative analyses showed eccentric hypertrophy of the left 
ventricle (remodeling index [MM/LV-EDV]: M 0.75, F 0.665), enlargement of the RV 
volumes (RV-EDV: M 122.6 ± 19.0 ml/m², F 99.9 ± 7.2 ml/m²) and an increased SV 
(LV-SV: M 64.7 ± 10.0 ml/m², F 56.5 ± 5.7 ml/m²; RV-SV; M 66.7 ± 10.4 ml/m², F 
54.2 ± 7.1 ml/m²). Abnormal findings were detected in 6 athletes (6.3 %) 
including one benign variant of coronary anomaly and abnormal late gadolinium 
enhancement in 2 cases. None of the athletes showed wall motion abnormalities or 
signs of myocardial ischemia.
CONCLUSION: CMR imaging of endurance athletes revealed abnormal findings in more 
than 5 % of the athletes. However, the prognostic significance remains unclear. 
Thus, cardiac MRI cannot be recommended as a routine examination in the care of 
athletes.