Alteration in Left Ventricular Strains and Torsional Mechanics After Ultralong Duration Exercise in Athletes

Abstract

Background-Numerous studies have reported evidence of cardiac injury associated with transient left ventricular (LV) systolic and diastolic dysfunction after prolonged and strenuous exercise. We used 2D ultrasound speckle tracking imaging to evaluate the effect of an ultralong-duration exercise on LV regional strains and torsion. We speculated that systolic dysfunction after exercise is associated with depressed LV strains and torsion, and diastolic dysfunction results from decreased and delayed untwisting, a key factor of LV suction and early filling. Methods and Results-Twenty-three triathletes underwent conventional and speckle tracking imaging echocardiography at rest before and immediately after an ultralong distance triathlon. Measurements included LV longitudinal, circumferential and radial strains, LV rotations, and LV torsion. After the race, LV systolic dysfunction was characterized by a decrease in LV longitudinal, radial, and circumferential strains, especially for apical radial strains (44.6Ϯ15.1% versus 31.1Ϯ13.8%, PϽ0.001). Peak torsion was slightly decreased (8.3Ϯ5.1°versus 6.4Ϯ3.9°, respectively, Pϭ0.09) and significantly delayed (91Ϯ18% versus 128Ϯ31% of systolic duration, PϽ0.001) beside end-ejection. Peak untwisting was also depressed and delayed beside isovolumic relaxation. Conclusions-This study documented major alterations in cardiac strains and torsion after an ultralong distance triathlon.LV systolic strains were depressed but not delayed, whereas twisting was decreased and delayed. This altered pattern hampered the rapid untwisting during isovolumic relaxation phase, reducing LV diastolic suction and early filling.

Progressive and biphasic cardiac responses during extreme mountain ultramarathon

“…At midrace (148 km; 47 Ϯ 7 h), SV was greater than at prerace, an observation in accordance with one of our previous studies after 38 h of running (39). Conversely, after shorter-duration exercises, SV was generally decreased (26,29,35,42). Of note, consequently to the higher SV, we observed a greater cardiac output at mid-and posttest.…”

The effect of incremental endurance exercise training on left ventricular mechanics: a prospective observational deformation imaging study

“…In our study, the discovery that IEET leads to an increase in LVtw might appear to contradict some prior studies (5,32). The lack of an athletic background of our study participants and the longitudinal study design might explain these results.…”

“…In contrast to this study, the present study, which featured longitudinal follow-up, did not include layer specific analysis. However, in some studies, the athletes' LV strain measurements were found to be similar to control groups (5,26). The seemingly discordant results may be explained by several factors, including study population (subject number), study design (longitudinal or case-control), athletic experience and strain measurements that might be affected by loading conditions.…”

“…Case control studies showed that professional soccer players (32) and cyclist (5) have significantly lower LVtw compared to sedentary controls. Chan-Dewar et al (20) reported no significant change in LV torsion in amateur male runners after they completed a marathon, whereas Nottin et al (5) observed that LV torsion were decreased and delayed after completion of an "Ironman" distance triathlon. Weiner et al (4) reported an increase in LV torsion after a 90 day period of exercise training when compared to before the training period.…”

“…This condition is described as athlete's heart or exercise related myocardial remodeling, and it is characterized by increases in the chamber size, wall thickness and left ventricular (LV) mass. Few studies have been conducted on how this structural alteration occurring in athletes affects LV mechanics (3)(4)(5)(6). In addition, most of the studies related to the effects of endurance training on cardiovascular functions in athletes are cross-sectional and only a few longitudinal studies involving the exercise related structural and functional alterations in the heart have been conducted (4,5).…”