Can exercise cause heart muscle changes that resemble cardiomyopathy?

Increased left ventricular trabeculation in athletes – a marker of left ventricular non-compaction or a physiological epiphenomenon of increased cardiac preload?

Supervised by Professor Sanjay Sharma, this Clinical Research Training Fellowship is focusing on finding out whether intense physical activity can cause heart muscle remodelling that resembles a rare heart muscle disease called Left Ventricular Non-Compaction Cardiomyopathy (LVNC). We do not fully understand how LVNC develops, and currently there are no tests that detect the condition with complete certainty. At the moment doctors diagnose LVNC using heart scans, which pick up the typical appearance of spongy heart muscle. Currently doctors think that LVNC may be inherited and that the spongy heart muscle is present from birth. But the St George’s team believe that spongy heart muscle changes seen on scanning may not be an ideal way to diagnose LVNC as similar changes in heart muscle can occur when the heart remodels in response to increased work. For instance, athletes and many pregnant women at term show spongy heart muscle changes on scans. In this project, the researchers will scan the hearts of healthy people training for their first marathon. They will use both echocardiograms and cardiac MRI scans at the beginning and at the peak of their training, and look for the development of spongy heart muscle. Using fitness tests and measuring central blood pressure, they aim to explain how spongy heart muscle might develop with high levels of exercise. They will follow up the athletes over a further period of detraining to see whether any remodelling detected in the heart is reversible. This research will confirm if intense physical activity can cause spongy heart muscle changes. The team hopes their findings can avoid inappropriate diagnosis of heart muscle disease in people with normal hearts, and avoid unnecessary anxiety, tests and family screening.