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Head-to-head comparison between echocardiography and cardiac MRI in the evaluation of the athlete's heart
  1. Niek H J Prakken1,
  2. Arco J Teske2,
  3. Maarten J Cramer2,
  4. Arend Mosterd2,3,4,
  5. Annieke C Bosker1,
  6. Willem P Mali1,
  7. Pieter A Doevendans2,
  8. Birgitta K Velthuis1
  1. 1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  4. 4Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
  1. Correspondence to Mr Arco J Teske, University Medical Center Utrecht, Division of Heart and Lungs, Department of Cardiology, HP F.02.352, Heidelberglaan100, 3582 CX Utrecht, The Netherlands, a.j.teske{at}


Objective Echocardiographic cut-off values are often used for cardiac MRI in athletic persons. This study investigates the difference between echocardiographic and cardiac MRI measurements of ventricular and atrial dimensions and ventricular wall thickness, and its effect on volume and wall mass prediction in athletic subjects compared with non-athletic controls.

Methods Healthy non-athletic (59), regular athletic (59) and elite athletic (63) persons, aged 18–39 years and training 2.5±1.9, 13.0±3.0 and 25.0±5.4 h/week, respectively (p<0.001), underwent echocardiography and cardiac MRI consecutively. Left ventricular (LV) and right ventricular (RV) dimensions were measured on both modalities. LV and RV end-diastolic and end-systolic volumes and LV wall mass were determined on cardiac MRI. Echocardiographic M-mode LV volumes (Teichholz formula) and LV wall mass (American Society of Echocardiography formula) were calculated.

Results LV and RV dimensions were smaller on echocardiography (p<0.001), and although the correlation with the cardiac MRI volume was good (p<0.01), the difference in volume was large (LV end-diastolic volume difference 93±32 g, p<0.001). LV wall thickness and calculated wall mass were significantly (p<0.001) larger on echocardiography (wall mass difference −101±34 g, p<0.001). Differences in absolute dimensions did not change significantly between non-athletic and athletic persons; however, the difference in echocardiographic estimations of LV volumes and wall mass did increase significantly with the larger athlete's heart, requiring possible correction of the standard echocardiographic formulas.

Conclusions Echocardiography shows systematically smaller atrial and ventricular dimensions and volumes, and larger wall thickness and mass, compared with cardiac MRI. Correction for the echocardiographic formulas can facilitate better intertechnique comparability. These findings should be taken into account in the interpretation of cardiac MRI findings in athletic subjects in whom cardiomyopathy is suspected on echocardiography.

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  • NHJP and AJT have joint first authorship.

  • Competing interest None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Institutional Ethics Committee of the University Medical Center Utrecht.

  • Provenance and peer review Not commissioned; externally peer reviewed.