Cardiac MRI in the Evaluation of the Athlete's Heart: Optimization of the 1.5 T Study Protocol and Experience from PTA Trani

Abstract

The athlete's heart represents the set of morphological, functional, and electrophysiological adaptations that develop 15 as a result of intense and prolonged physical activity, aimed at improving muscular performance and ensuring optimal 16 hemodynamic support during exercise. The increase in sports participation, both at amateur and competitive levels, 17 has made accurate cardiac assessment essential to distinguish between physiological changes and pathological condi-18 tions, such as hypertrophic and dilated cardiomyopathy, and to reduce the risk of acute muscular events, including 19 arrhythmias or sudden cardiac death (SCD). In this context, cardiac magnetic resonance (CMR) has emerged as an 20 excellent diagnostic tool, allowing for the characterization of myocardial tissue, quantification of ventricular volumes, 21 and identification of fibrosis or inflammatory processes. This thesis aims to develop and optimize a 1.5 Tesla CMR 22 protocol specifically designed for the athlete's heart, based on the experience gained at the Trani Territorial Health 23 Center. The methodology included a review of the scientific literature, analysis of key imaging sequences (cine-SSFP, 24 T1/T2 mapping, late gadolinium enhancement), practical experiments aimed at optimizing imaging times and quality, 25 and analysis of clinical cases to distinguish physiological adaptations from pathological alterations. The results allowed 26 us to identify optimal sequences and parameters for accurate morphological and functional assessments, improving 27 diagnostic capacity and measurement reproducibility compared to standard protocols. This work highlights the im-28 portance of a structured and personalized cardiac magnetic resonance (CMR) approach for athletes, providing practical 29 tools to ensure cardiovascular safety and the early detection of abnormalities that are often not evident with other 30 methods