Late gadolinium enhancement (LGE) in long time endurance athletes may not mean scar tissue (in the sense of replacement scar tissue ) and may represent a "benign" finding.All LGE may not mean the same type of tissue alteration.That particularly applies to LGE at the insertion points of the right ventricle (RVIP).
See Grogoratos,c clinical importance of late gadolinium enhancement at right ventricular insertion point Int J cardiovascular imaging 2020 .
and Shambhag SM et al https://academic.oup.com/eurheartj/article/40/6/529/5185127
"... LGE at the RVIP ( right ventricular insertion points) has been proposed to represent focal plexiform fibrosis (associated with myocardial disarray rather than replacement fibrosis" Bravo, PC, Late gadolinium enhancement confirmed to the right ventricular insertion points in hypertrophic cardiomyopathy an intermediate stage phenotype, European heart journal cardiovascular imaging, 2016 Mar 17(3) 293 /// this article references the following as the source of the plexiform fibrosis pattern
One key question is does plexiform fibrosis pose the risk of inciting an arrythmia that does replacement fibrosis.
See also Moor, JC, The histological basis of late gadolinium enhancement in cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy. Amer Coll cardio 2004 43 2260