https://orcid.org/0000-0001-7842-6202
Cardiac magnetic resonance (CMR) is increasingly prescribed in sport cardiology during pre-participation screening. Common indications are electrocardiography abnormalities, rhythm disturbances, cardiovascular symptoms like syncope, family history for hereditary cardiomyopathy or sudden death, which are all conditions that increase the likelihood of underlying cardiac disease at risk of arrhythmic events with exercise. However, despite its unique capability of tissue characterization and accurate thickness, volume, and function estimation, CMR can be prone to false-positive findings, especially during late gadolinium enhancement (LGE) assessment, leading to cardiac disease overdiagnosis and inappropriate disqualification from competitive sports activity. Herein, we report the case of a 45-year-old male middle distance runner, who came to our attention for frequent premature ventricular beats. Arrhythmias had a prevalent right bundle branch morphology and showed a mild worsening in amount and complexity during effort. Echocardiogram was unremarkable. Conversely, the CMR post-contrast images detected a mid-wall hyperintense signal on basal interventricular septum, which was interpreted as LGE, thus raising concern for a subclinical myocardial damage (Panel A). A subsequent coronary computed tomography angiography (CCTA) excluded coronary atherosclerosis and course/origin anomalies (Panel B). However, after reconstruction and merging of CCTA and CMR images, an overlapping between the course of a septal perforator coronary branch and the mid-wall septal hyperintense signal was evident (Panel C), suggesting a correlation between the two findings.
Mid-wall septal LGE can reflect contrast enhancement due to the normal course of septal perforator coronary arteries, rather than myocardial injury. Cardiac imaging readers should be aware of this, in order to prevent cardiac disease overdiagnosis and inappropriate sport disqualification.
