Signs of subclinical myocarditis in a cohort of professional football players: a magnetic resonance imaging and genetic test study

Abstract

Athletes possess greater relative risk of sudden death due to cardiovascular causes, where autopsies reveal myocardial fibrosis. Although hypertrophic cardiomyopathy (HCM) has been consistently reported to be the single most common cause of cardiovascular death, myocarditis can also be an important entity in this population. A cohort of 25 healthy male professional football (soccer) players (mean age 31±4 years old), with a high dynamic (isotonic) component training history was studied. A complete cardiovascular evaluation including anamnesis, physical examination, 12-lead ECG, magnetic resonance imaging (MRI) with delayed enhancement sequences and genetic analysis (MYH7, MYBPC3, ACT1, PKP2, DSP, DSG2, TAZ/G4.5, ZASP/LDB3 and DTNA genes) was performed. Seven out of 25 athelets (28%) had an abnormal MRI study. Four of them (16%) had signs compatible with myo-pericarditis (three had subepicardial fibrosis and one had pericardial effusion). In five (20%) players, LV apical hyper trabeculation (two with diagnostic criteria of LV non-compaction) was found. EKG repolarization abnormalities were detected in four (16%) athletes. No mutations were detected in the cardiomyopathy genetic tests. In conclusion, in a professional football players population, magnetic resonance imaging can detect signs of myocarditis, which could be a singular entity affecting this high dynamic component sport.