The Impact of Marathon Running Upon Ventricular Function as Assessed by 2D, Doppler, and Tissue‐Doppler Echocardiography

Abstract

The impact of prolonged exercise upon right ventricular (RV) function is poorly understood and to date no studies have utilized tissue-Doppler imaging (TDI). Thirty-five marathon runners (age range 18-50 years) volunteered for the study. Two-dimensional, pulsed Doppler, and TDI studies were performed one day before and immediately following race completion. Right and left ventricular (LV) longitudinal TDI myocardial velocities were acquired from the tricuspid annulus and mitral annulus, providing velocity data during systole (S'), early diastole (E'), and late diastole (A'). Transtricuspid and transmitral, early diastolic (E), and late diastolic (A) velocities and ratios were assessed using conventional pulsed-wave Doppler. RV and LV fractional area changes (FAC) were calculated from RV and LV end-diastolic and end-systolic areas recorded from 2D scans in a subsample (n = 23). RV myocardial velocities were unchanged pre-post race in S' (21.1 +/- 2.7 to 21.7 +/- 4.5 cm s(-1), P > 0.05), reduced in E' (23.3 +/- 3.5 to 19.9 +/- 5.3 cm s(-1), P < 0.05), increased in A' (19.1 +/- 3.6 to 23.7 +/- 6.8 cm s(-1), P < 0.05) with a resultant decline in E'/A' (1.28 +/- 0.36 to 0.94 +/- 0.45, P < 0.05). This pattern of data was mirrored in the LV. Similarly both pulsed-Doppler tricuspid and mitral E/A ratios decreased from pre- to postrace (P < 0.05). FAC for the RV and LV were unaltered postrace (P > 0.05). The impact of differing age, finishing time (173-330 min), hemodynamic loading and heart rate upon RV and LV function pre- to postrace was negligible. In conclusion, TDI and 2D data, for both the RV and LV demonstrated little change in systolic function after a marathon race. Conversely, a reduction in diastolic function was observed in both ventricles for which a mechanism has yet to be deduced.

Progressive and biphasic cardiac responses during extreme mountain ultramarathon

“…Although previous studies evaluated cardiac function following endurance exercise such as marathons, ironman triathlons, or MUMs (7,20,22,28,42), the present study is the first to investigate alterations in cardiac function induced by a MUM Ͼ100 h (i.e., during several days) and the first to include a measurement performed during the event. We observed that a MUM run over 4 -7 days induced 1) a specific and progressive increase of SV from pre-to postrace concomitant with an increase in diastolic filling and 2) a biphasic adaptation of HR, LV strain rates, with an initial increase from pre-to midrace and a return to baseline values from mid-to postrace.…”

“…IT IS WELL DOCUMENTED THAT prolonged intense exercise, such as a marathon or Ironman triathlon, transitorily alters cardiac function (7,13,20,22,23,28,42). A range of 3-15 h exercising induces transient left ventricular (LV) global systolic (20, 42) and diastolic (7,23,28) dysfunctions. This phenomenon, named exercise-induced cardiac fatigue (EICF), is generally associated with the release of biochemical markers of myocardial damage (13,22).…”

“…A range of 3-15 h exercising induces transient left ventricular (LV) global systolic (20,42) and diastolic (7,23,28) dysfunctions. This phenomenon, named exercise-induced cardiac fatigue (EICF), is generally associated with the release of biochemical markers of myocardial damage (13,22).…”

Early subclinical increase in pulmonary water content in athletes performing sustained heavy exercise at sea level: ultrasound lung comet-tail evidence

“…Hemodynamic changes are one of several potential factors contributing to the mechanisms of ULCs. pulmonary edema EVEN IN HEALTHY SUBJECTS EXTREMELY demanding endurance exercise leads to functional and structural cardiac and pulmonary changes, along with local and systemic responses, reflecting oxidative, metabolic, hormonal, and thermal stress, besides immunomodulation and inflammatory reaction (4,30,32,40,41,46). Whether interstitial pulmonary edema occurs in athletes performing heavy sea level exercise is debated (2,6,12,18,19,27,28,44,56).…”

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

“…1 On the other hand, prolonged intense exercise, such as marathon or long distance triathlon, may cause myocardial damages as evidenced by the release of cardiac specific biochemical markers. [2][3][4][5][6] These damages are associated with a transient impairment in cardiac function characterized by global systolic 7,8 and diastolic 3,9,10 dysfunction. However, whether this dysfunction is contingent or results from an alteration in intrinsic myocardial properties is an ongoing debate.…”