Stress CMR as a measure to separate athletic hearts from early dilated cardiomyopathies

Motivation: Exercise-induced cardiac adaptations can manifest as left ventricular (LV) dilatation and mildly reduced LV ejection fraction (LVEF), which makes the differentiation of an athletic heart from early dilated cardiomyopathy (DCM) challenging. This overlap of clinical uncertainty is termed 'grey zone' being at risk of misdiagnosis. Goal(s): To distinguish exercise adaptions from early DCM by cardiovascular magnetic resonance (CMR). Approach: Adding dobutamine stress imaging to CMR to separate an athletic heart from early DCM by comparing grey zones, athletes, DCMs, and healthy controls. Results: Athletic grey zones cleanly separated from early DCM grey zones when using stress CMR. Impact: Addition of dobutamine stress imaging during clinical CMR is a short, safe and feasible add-on, which markedly improves the ability of CMR to separate athlete's heart from early DCM.