Sub-clinical systolic dysfunction with persistent myocardial edema and inflammation in elite high-endurance athletes with common colds: a cardiovascular magnetic resonance study

Basic research has demonstrated that myocardial inflammation may be a feature of systemic viral inflammation, resulting from agents such as influenza. Physical activity during exposure to pathogens has been shown to exacerbate the propensity to develop adverse cardiac events. As such, based upon empirical findings, current guidelines on athletic training deter athletes from participating in sport during common colds. Cardio-vascular Magnetic Resonance (CMR) allows for non-invasive visualization of myocardial inflammation, where it has emerged as the imaging modality of choice to assess the course of myocarditis. Thus, using CMR-based tissue characterization, we hypothesized that colds in elite high-endurance athletes would lead to depressed cardiac function and myocardial inflammation.

62 (32 male, 31 ± 13 years) elite high-endurance athletes were prospectively recruited. CMR scans were performed at baseline, with an acute common cold, and 4 weeks after. Pre-defined symptoms were used to rule in an acute cold. LV function, edema, and myocardial inflammation were assessed using standard SSFP, T2-, and T1-weighted imaging, respectively, on a 1.5 T MRI system.

Standard, previously described approaches for the quantification of LV function, edema and myocardial inflammation were utilized. Statistical comparisons were performed with repeated measures ANOVA, at 2 levels of measurement.

We provide first evidence of sub-clinical myocardial involvement with common colds in high-endurance athletes. Colds were associated with a small yet significant decrease of systolic function, and persisting myocardial inflammation visualized with CMR-derived markers for edema and inflammation. Further research is required to investigate the implications of these findings on athletic performance.