# Introducing Cardiac Magnetic Resonance in Athlete Screening: An Initial Moroccan Experience With Professional Football Players

## TL;DR

This study explores how cardiac magnetic resonance (CMR) can improve cardiovascular screening for professional football players in Morocco, revealing both normal physiological changes and previously undetected heart conditions.

## Contribution

The paper presents an initial Moroccan experience integrating CMR into athlete screening, highlighting its diagnostic value in inconclusive cases.

## Key findings

- CMR confirmed physiological cardiac remodeling in athletes with borderline echocardiographic results.
- CMR identified previously undetected cardiomyopathies like apical hypertrophic cardiomyopathy and Fabry disease.
- Myocardial abnormalities were revealed in athletes with isolated electrocardiographic abnormalities and normal echocardiograms.

## Abstract

Background and objectives

Pre-participation cardiovascular screening in athletes relies primarily on electrocardiography and transthoracic echocardiography. While cardiac magnetic resonance (CMR) is increasingly recognized as a valuable complementary imaging modality, its integration into routine athlete evaluation remains variable across healthcare settings. In our context, the recent expansion of access to CMR has enabled its use as a second-line tool in professional athletes initially assessed by first-line screening examinations. This study aimed to describe CMR findings in asymptomatic professional football players referred after echocardiographic or electrocardiographic screening in a Moroccan tertiary center.

Methods

This descriptive study included 300 asymptomatic male professional football players aged 18 to 30 years who underwent routine pre-participation cardiovascular screening, including electrocardiography and transthoracic echocardiography, between January 2023 and June 2024. Among them, 40 players were referred for CMR based on clinical judgment following inconclusive echocardiographic findings or isolated electrocardiographic abnormalities. CMR findings were analyzed descriptively with respect to cardiac morphology, ventricular volumes, myocardial thickness, myocardial tissue characterization, and final diagnostic classification.

Results

Among the players referred for CMR, a broad spectrum of findings was observed. In several cases, CMR clarified borderline echocardiographic measurements by confirming physiological cardiac remodeling related to intensive football training. In other athletes, CMR identified previously unrecognized structural cardiomyopathies, including apical hypertrophic cardiomyopathy and a presentation suggestive of Fabry disease, which had not been detected on initial echocardiography. In players referred solely for isolated electrocardiographic abnormalities despite normal echocardiographic findings, CMR revealed clinically relevant myocardial abnormalities in a notable proportion of cases. Overall, CMR contributed to improved anatomical and tissue characterization in athletes with inconclusive first-line screening results.

Conclusion

In this descriptive Moroccan experience, CMR provided valuable morphological and tissue-level information in asymptomatic professional football players referred after initial cardiovascular screening. The growing accessibility of CMR in our setting has allowed more refined diagnostic evaluation beyond first-line examinations, particularly in athletes with equivocal findings. These observations highlight the practical role of CMR as a complementary imaging modality within contemporary athlete screening pathways in resource-evolving healthcare systems.