Detection of Cardiovascular Disease in Elite Athletes Using Cardiac Magnetic Resonance Imaging

This German study used cardiac MRI to screen 95 elite competitive athletes for cardiovascular abnormalities that could increase sudden cardiac death risk — applying a high-resolution imaging tool to a population where distinguishing pathological from adaptive cardiac remodeling is clinically challenging.

CMR detected abnormalities in 6.3 percent of athletes, including coronary artery anomalies and late gadolinium enhancement (a marker of myocardial fibrosis). The majority showed normal anatomy alongside the expected adaptive remodeling of the endurance-trained heart — increased chamber volumes and wall thickness that can mimic hypertrophic cardiomyopathy on simpler assessments.

The clinical relevance is limited by both the small sample and the absence of outcome data. The study documents what CMR can detect in elite athletes, not whether those findings predict events or should alter management decisions. The authors appropriately conclude that CMR is not suitable for routine screening in this population.

We rate the evidence limited. A small observational study characterizing CMR findings in elite athletes without linking those findings to cardiovascular outcomes or demonstrating that screening changes management beneficially.