A study from Spain (1)demonstrated late gadolinium enhancement in 37 % of highly trained young endurance athletes, all of which occurred at the insertion points of the right ventricle into the inter ventricular septum.See here for full text of article.
All of the athletes trained at least 7 hours per week for the previous five years.Compared to controls the study group had a 10 fold increase in late gadolinium enhancement (LGE) .
LGE is seen in patients with coronary artery disease with a post myocardial infarction scar and in cardiomyopathy patients in whom the LGE may be considered a negative prognostic sign.
Early reports of LGE in older , long time endurance athletes were confusing and in one study confounded by a significant number of cigarettes smokers. Some of the cases demonstrated a coronary artery pattern ( i.e. LGE along the distribution pattern of the coronary arteries ) and some did not and some were noted in the insertion point of the right ventricle.
The authors described the LGE as a possible "matrix remodeling" and along with bi-atrial and bi-ventricular chamber size increase and superior diastolic function characterizes the pattern of the so-called athlete's heart.
1)Domenech-Ximenos, Prevalence and pattern of cardiac magnetic resonance in highly trained endurance athletes Journal of cardiovascular Magnetic Resonance 2020 Sept 3, 22,(1) 62