Exploring the determinants of the cardiac changes after ultra-long duration exercise: The echocardiographic Spartathlon study

Abstract

Aim The investigation of the pathophysiological determinants of cardiac changes following ultra-long duration exercise. Methods Twenty-seven runners who finished a 246 km running race were examined both before and after the finish of the race. Examinations included echocardiography and measurement of body weight and blood biochemical parameters. Results Exercise increased left ventricular end-diastolic interventricular septum thickness (LVIVSd) ( p < 0.001) and posterior wall thickness (LVPWTd) ( p = 0.001) and right ventricular end-diastolic area ( p = 0.005), while reduced tricuspid annular plane systolic excursion (TAPSE) ( p = 0.004). A minor decrease in the peak absolute values of both left ventricular (from −20.9 ± 2.3% to −18.8 ± 2.0%, p = 0.009) and right ventricular (from −22.9 ± 3.6% to −21.2 ± 3.0%, p = 0.040) global longitudinal strains occurred. There was decrease in body weight ( p < 0.001) and increase in both circulating high-sensitivity troponin I ( p = 0.028) and amino-terminal pro-B type natriuretic peptide (NT-proBNP) ( p = 0.018). The change in the sum of LVIVSd and LVPWTd correlated negatively with percentage change of body weight ( r = −0.416, p = 0.049). The only independent determinant of post-exercise NT-proBNP was pulmonary artery systolic pressure ( r = 0.797, p = 0.002). Post-exercise NT-proBNP correlated positively with percentage changes of basal (RVbas) ( r = 0.582, p = 0.037) and mid-cavity (RVmid) ( r = 0.618, p = 0.043) right ventricular diameters and negatively with percentage change of TAPSE ( r = −0.720, p = 0.008). Similar correlations with RVbas, RVmid and TAPSE were found for pulmonary artery systolic pressure. Post-exercise high-sensitivity troponin I correlated negatively with percentage change of body weight ( r = −0.601, p = 0.039), but was not associated with any cardiac parameter. Conclusion The main cardiac effects of ultra-long duration exercise were the decrease in left ventricular end-diastolic dimensions and increase in left ventricular wall thickness, as well as minimal dilatation and alteration in systolic function of right ventricle, possibly due to the altered exercise-related right ventricular afterload.

From Athens to Sparta—37 Years of Spartathlon

“…Acute physiological and pathophysiological responses to Spartathlon have been examined regarding several aspects, including bone metabolism [ 10 ], heart function [ 11 ], incidence of hyponatremia [ 12 ], and circulating stress-related proteins [ 13 ]. Only the world’s best ultra-marathoners are able to finish the event or to win Spartathlon [ 14 , 15 ].…”

Cardiac remodelling and exercise: What happens with ultra-endurance exercise?

“…An ultra-marathon is classed as any race that is longer than the 42.2-km distance of a regular marathon race distance. The study population for this report by Christou et al 1 had a mean finishing time for the Spartathlon of 33 hours, 34 minutes and 27 seconds (2014 minutes). Therefore, the Spartathlon race alone represents 27 times the weekly vigorous exercise recommendations, demonstrating the enormity of this ultramarathon.…”

Focus on exercise and sport cardiology

“…In this issue of the journal the paper by Christou et al., examining 27 runners who finished a 246 km SPARTATHLON race, adds important information to our understanding of the impact of a single episode of extreme vigorous exercise over a relatively short time frame. 6…”