The effect of age in the cardiac MRI evaluation of the athlete's heart



Increasing age is accompanied by a higher risk of sports-related death, especially from coronary disease and cardiomyopathies. It is unclear if the mature athlete's heart differs from young athletes. Our aim was to assess the effect of age on ventricular volumes and wall-mass. We also established maximum cardiac MRI (CMR) reference values in mature athletes to facilitate differentiation from cardiomyopathy.

143 healthy persons aged 40-60 years (mean age 49±6 years [±SD], 39% women) underwent CMR: 78 athletes (exercising 9-18 h/week), and 65 age and gender matched non-athletes (≤3 h/week). From a larger study, cardiac MRI data of 195 healthy persons aged 18-39 years (mean age 28±6, 48% women) were included for statistical analysis: 81 athletes and 114 matched non-athletes.




With multivariate analysis, age only has limited effect on ventricular volumes (LV 1%, RV 3%) and wall-mass (0.01%). Only athletes show significant decrease in right and left ventricular volumes and LV-mass with increasing age (p<0.05). RV wall-mass remains unaffected by age. Ventricular diameters, volumes and wall-mass are significantly lower in mature athletes compared to young athletes, and significantly higher compared to mature non-athlete controls (p<0.05).

Only athletes show a significant decrease in ventricular volumes and LV wall-mass with increasing age, which probably reflects decreasing training intensity rather than the effect of age. Mature athletes form a distinct group requiring separate reference values as they have significantly lower ventricular volumes and wall-mass as compared to young athletes, however, still significantly higher values than mature non-athletes.

Body Surface Area (BSA) indexed means, stratified for gender and endurance training level (no elite- athletes)

Data are expressed as mean ±SD; n = number of sampled subjects;  BSA = body surface area;
RV, LV = right and left ventricle; EDV = end-diastolic volume (mL); Wall-mass = end-diastolic wall-mass (g); BP = Blood Pressure in mmHg