The acute impact of an ultramarathon on right heart: A 12‐lead ECG study

Abstract

Background Some concerns exist about possible detrimental effects on cardiac function of ultra‐endurance competitions. The aim of this study was to evaluate the acute effects of an ultramarathon by comparing pre‐ and post‐race 12‐lead ECG features. Methods A total of 301 competitive athletes (mean age: 48 ± 9 years) running a 50‐km ultramarathon were analyzed. Twelve‐lead ECG was collected the day before the race and immediately at the finish line. According to the Italian law, athletes could have participated only after undergoing pre‐participation screening that ruled out the presence of an underlying heart disease. Results After the race a significant increase in P‐wave voltage (P < .001) and P‐wave duration (P < .001) was found as compared to pre‐race data with a higher percentage of athletes fulfilling the ECG criteria for right atrial enlargement (RAE; from 3% to 17%, P < .001). The presence of RAE post‐race significantly correlated with age, hours of training/week, and years of training and inversely with time at the finish line and the final position in the ranking. T‐wave and R‐wave amplitude (P < .001) and QTc‐interval duration (P < .001) significantly increased after the race. No significant differences in terms of supraventricular or ventricular arrhythmias were found. Conclusions A sizeable proportion of athletes running a 50‐km ultramarathon demonstrated post‐race ECG signs of right heart overload but no arrhythmias. This finding supports the hypothesis that ultra‐endurance races may induce transient right heart overload.

Analysis of food and fluid intake in elite ultra-endurance runners during a 24-h world championship

“…Ultramarathon races (> 42.195 km) have gained popularity in the last two decades [ 1 – 3 ] and are now used as experimental models to assess the effects of sleep deprivation [ 4 , 5 ] and muscular [ 6 , 7 ] and cardiac [ 8 , 9 ] damage. Most of the focus has been on the analysis of nutritional and fluid intake [ 10 , 11 ].…”

Criteria for interpretation of the athlete's ECG: A critical appraisal

“…Endurance exercise implies acute hemodynamic changes that translate into electrocardiographic alterations, being detectable immediately or shortly after the end of the competition/training. Increase of P‐wave voltages, prolongation of P‐wave duration, right atrial enlargement, increase in R‐wave amplitude in V1, and rightward shift in the QRS axis have all been observed after an ultramarathon race, possibly reflecting acute right heart overload 52 . The plethora of acute ECG modifications herein described warrant to postpone the ECG acquisition for preparticipation screening purpose at least the day after a substantial and prolonged physical effort.…”

“…Increase of P-wave voltages, prolongation of P-wave duration, right atrial enlargement, increase in R-wave amplitude in V1, and rightward shift in the QRS axis have all been observed after an ultramarathon race, possibly reflecting acute right heart overload. 52 The plethora of acute ECG modifications herein described warrant to postpone the ECG acquisition for preparticipation screening purpose at least the day after a substantial and prolonged physical effort. Electrical instability of the myocardium may endure until full recovery of electrolytic imbalance.…”

“…Robust data indicate that black athletes show a higher prevalence of abnormal ECGs compared to their white counterparts, irrespective of the criteria employed. 22,29,52 Applying the International criteria, Malhotra et al found a 3.6% abnormal ECGs among 1005 black soccer players, whereas in another study involving 519 professional basketball players this percentage rocketed to 15.6%. 29,53 In this latter cohort, the benefit of excluding borderline variants (31%) was offset by the high prevalence of TWI in inferior and/or lateral leads (6.2%) and long QT-interval (4.8%).…”

(Right ventricle in athletes)

“…Systolická funkce PK zůstává kontroverzním tématem a u sportovců byly popsány jak normální, tak i supranormální či mírně snížené hodnoty. 2,4,8,[16][17][18] Při dlouhotrvající intenzivní zátěži byla u některých jedinců popisována myokardiální fi bróza v různých lokalizacích. Její prognostický význam není stále zcela jasný.…”