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Lima FVP, Andrade DDM, Filho JE, Souza PL, Azevedo LF, Coelho MM, de Lima JRP, Trevizan PF, Laterza MC, Martinez DG. Acute effect of ultramarathon on systolic and diastolic cardiac function: Systematic review and meta-analysis. Int J Cardiol 2024; 408:132106. [PMID: 38705202 DOI: 10.1016/j.ijcard.2024.132106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Ultramarathon running poses physiological challenges, impacting cardiac function. This systematic review and meta-analysis explore the acute effects of single-stage ultramarathon running on cardiac function. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were followed. Searches covered Medline, Embase, CINAHL, SPORTDiscus, Web of Science, Central Cochrane, and Scopus. Random effects meta-analyses assessed left ventricular (LV) and right ventricular (RV) variables, expressed as mean differences (MD) with 95% confidence intervals (CI). RESULTS Among 6972 studies, 17 were included. Post-ultramarathon reductions were found in LV end-diastolic diameter (LVEDD) (-1.24; 95% CI = -1.77, -0.71 mm), LV end-diastolic volume (LVEDV) (-9.92; 95% CI = -15.25, -4.60 ml), LV stroke volume (LVSV) (-8.96 ml, 95% CI -13.20, -4.72 ml), LV ejection fraction (LVEF) (-3.71; 95% CI = -5.21, -2.22%), LV global longitudinal strain (LVGLS) (-1.48; 95% CI = -2.21, -0.76%), E/A (-0.30; 95% CI = -0.38, -0.22 cm/s), .E' (-1.35 cm/s, 95% CI -1.91, -0.79 cm/s), RV fractional area change (RVFAC) (-3.34, 95% CI = -5.84, -0.84%), tricuspid annular plane systolic excursion (TAPSE) (-0.12, 95% CI = -0.22, -0.02 cm), RV global longitudinal strain (RVGLS) (-1.73, 95% CI = -2.87, -0.59%), with increases in RV end-diastolic area (RVEDA) (1.89, 95% CI = 0.63, 3.14 cm2), RV Peak A' (1.32 cm/s, 95% CI 0.20, 2.44), and heart rate (18.24, 95% CI = 15.16, 21.32). No significant differences were observed in LV end-systolic diameter (LVESD), LV end-systolic volume (LVESV), RV end-diastolic diameter (RVEDD), RV Peak E', and RV Peak S'. CONCLUSIONS Evidence suggests immediate impairment of systolic and diastolic cardiac function post-ultramarathon running.
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Affiliation(s)
- Francisco Veríssimo Perrout Lima
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil.
| | - Diana de Medeiros Andrade
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - José Elias Filho
- Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Pedro Lima Souza
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Luciene Ferreira Azevedo
- Echocardiography Unit, University of São Paulo. Av. Dr. Enéas de Carvalho Aguiar, São Paulo, SP 44 - 05403-900, Brazil
| | - Marcelo Martins Coelho
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Jorge Roberto Perrout de Lima
- Faculty of Physical Education and Sports, Federal University of Juiz de Fora. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Patrícia Fernandes Trevizan
- Department of Physical Therapy, Federal University of Minas Gerais. Av. Presidente Carlos Luz, 6627 - Pampulha, Belo Horizonte, MG 31310-25, Brazil
| | - Mateus Camaroti Laterza
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Daniel Godoy Martinez
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
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Kodesh E, Navot-Mintzer D, Livshitz L, Shub I, Or T. The effects of a multi-day cross-country mountain bike race on myocardial function, stress, inflammation and cardiac biomarkers in amateur master athletes. Res Sports Med 2024; 32:425-442. [PMID: 36134901 DOI: 10.1080/15438627.2022.2125316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
This study aimed to examine the effects of a multi-day mountain bike race on amateur master athlete cyclists (AMA). AMA (50±5 years) completed 2 stages of a mountain bike race. Six weeks before racing, echocardiography, blood and maximal cardiopulmonary exercise tests (CPET) were performed. One hour after completion of each race stage, echocardiography measurements were taken and blood was sampled for stress, inflammatory and cardiac biomarkers. Main outcomes of the CPET were maximal oxygen consumption (VO2max) 50.7±6.5 ml/kg/min; maximal power 328±45 Watt and ventilatory threshold of 86%VO2max. Participants completed 95.7km with an elevation of 1650m on the first day, and 92.5km with an elevation of 1410m on the second day, with completion times of 357±42 and 390 ±43 minutes, respectively. After racing, increases in Creatine Phosphokinase and C-reactive protein (3-6 fold) (p<0.001), Troponin I (4-fold) (p<0.001) and N-terminal pro-brain natriuretic peptide (NT-Pro BNP) (4-7-fold) (p<0.001) were noted, with a reduction in the myocardial global work index of 17-24% (p<0.001). No correlations were found between Troponin I or NT-Pro BNP and myocardial global work index. Highly aerobically fit AMA participating in demanding endurance events demonstrated elevated stress, inflammatory, muscle damage and cardiac biomarkers. However, these changes did not significantly correlate with altered cardiac function. In addition, consecutive days of demanding prolonged cycling exercise did not have cumulative effects on the measured myocardial parameters.
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Affiliation(s)
- Einat Kodesh
- Physical Therapy department, University of Haifa, Haifa, Israel
| | - Dalya Navot-Mintzer
- The Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya, Israel
| | - Liora Livshitz
- Cardiology Department, Galilee Medical Center, Nahariya, Israel
| | - Idit Shub
- The Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya, Israel
| | - Tsafrir Or
- Cardiology Department, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Israel
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Berger NJA, Best R, Best AW, Lane AM, Millet GY, Barwood M, Marcora S, Wilson P, Bearden S. Limits of Ultra: Towards an Interdisciplinary Understanding of Ultra-Endurance Running Performance. Sports Med 2024; 54:73-93. [PMID: 37751076 DOI: 10.1007/s40279-023-01936-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
Ultra-endurance running (UER) poses extreme mental and physical challenges that present many barriers to completion, let alone performance. Despite these challenges, participation in UER events continues to increase. With the relative paucity of research into UER training and racing compared with traditional endurance running distance (e.g., marathon), it follows that there are sizable improvements still to be made in UER if the limitations of the sport are sufficiently understood. The purpose of this review is to summarise our current understanding of the major limitations in UER. We begin with an evolutionary perspective that provides the critical background for understanding how our capacities, abilities and limitations have come to be. Although we show that humans display evolutionary adaptations that may bestow an advantage for covering large distances on a daily basis, these often far exceed the levels of our ancestors, which exposes relative limitations. From that framework, we explore the physiological and psychological systems required for running UER events. In each system, the factors that limit performance are highlighted and some guidance for practitioners and future research are shared. Examined systems include thermoregulation, oxygen delivery and utilisation, running economy and biomechanics, fatigue, the digestive system, nutritional and psychological strategies. We show that minimising the cost of running, damage to lower limb tissue and muscle fatigability may become crucial in UER events. Maintaining a sustainable core body temperature is critical to performance, and an even pacing strategy, strategic heat acclimation and individually calculated hydration all contribute to sustained performance. Gastrointestinal issues affect almost every UER participant and can be due to a variety of factors. We present nutritional strategies for different event lengths and types, such as personalised and evidence-based approaches for varying types of carbohydrate, protein and fat intake in fluid or solid form, and how to avoid flavour fatigue. Psychology plays a vital role in UER performance, and we highlight the need to be able to cope with complex situations, and that specific long and short-term goal setting improves performance. Fatigue in UER is multi-factorial, both physical and mental, and the perceived effort or level of fatigue have a major impact on the ability to continue at a given pace. Understanding the complex interplay of these limitations will help prepare UER competitors for the different scenarios they are likely to face. Therefore, this review takes an interdisciplinary approach to synthesising and illuminating limitations in UER performance to assist practitioners and scientists in making informed decisions in practice and applicable research.
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Affiliation(s)
- Nicolas J A Berger
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
| | - Russ Best
- Centre for Sport Science and Human Performance, Wintec, Hamilton, New Zealand
| | - Andrew W Best
- Department of Biology, Massachusetts College of Liberal Arts, North Adams, MA, USA
| | - Andrew M Lane
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - Guillaume Y Millet
- Univ Lyon, UJM Saint-Etienne, Inter-University Laboratory of Human Movement Biology, Saint Etienne, France
- Institut Universitaire de France (IUF), Paris, France
| | - Martin Barwood
- Department of Sport, Health and Nutrition, Leeds Trinity University Horsforth, Leeds, UK
| | - Samuele Marcora
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Patrick Wilson
- Department of Human Movement Sciences, Old Dominion University, Norfolk, VA, USA
| | - Shawn Bearden
- Department of Biological Sciences, Idaho State University, Pocatello, ID, USA
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Hu S, Zhang H, Ma H, Yang C, Hu P, Gao F. Assessment of right ventricular structure and systolic function in amateur marathon runners using three-dimensional speckle tracking echocardiography. Int J Cardiovasc Imaging 2023; 39:1473-1482. [PMID: 37178419 PMCID: PMC10427556 DOI: 10.1007/s10554-023-02869-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Prolonged high-intensity endurance exercise has been reported to have adverse effects on the heart, which are further correlated with exercise dose. However, its effect on the right ventricle (RV) of amateur runners is unknown. This study aimed was to evaluate the early right ventricular structure and systolic function of amateur marathon runners by three-dimensional speckle tracking echocardiography (3D-STE), and to further analyze the correlation between relevant parameters and the amount of training. A total of 30 amateur marathon runners (marathon group) and 27 healthy volunteers (control group) were enrolled. Conventional echocardiography combined with 3D-STE was performed in all subjects, and the marathon group was screened by echocardiography a week before a marathon (V1), within 1 h post-marathon (V2), and 4 days post-marathon (V3). RV global longitudinal strain (GLS) and RV end-diastolic volume (EDV) increased significantly in the marathon group compared to the control group (P < 0.05). RV GLS was significantly decreased in the marathon group within 1 h post-marathon (V1: - 26.2 ± 2.5% vs V2: - 23.0 ± 1.6% vs V3: - 25.6 ± 2.6%, P < 0.001). However, there was no significant difference in RV ejection fraction (RVEF) (P > 0.05). The results of the correlation analysis showed that RV EDV and RV end-systolic volume (ESV) were positively correlated with the average training volume (P < 0.001). Multivariate linear regression analysis showed that average training volume was an independent predictor of RV EDV in amateur marathoners (β = 0.642, P < 0.001). The systolic function of the RV was enhanced in amateur marathon runners in the early stage, manifested by an increase in RV EDV. After a long period of high-intensity endurance exercise, RV systolic function will temporarily be reduced. 3D-STE can identify this subclinical change with high sensitivity and provide valuable information to assess the structure and function of RV in amateur marathon runners.
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Affiliation(s)
- Shanting Hu
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Hebin Zhang
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
- Hangzhou Institute of Sports Medicine for Marathon, Hangzhou, China
| | - Hui Ma
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Cunxin Yang
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
| | - Peipei Hu
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
| | - Feng Gao
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China.
- School of Medicine, Hangzhou Normal University, Hangzhou, China.
- Hangzhou Institute of Sports Medicine for Marathon, Hangzhou, China.
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Coates AM, Millar PJ, Burr JF. Investigating the roles of exercise intensity and biological sex on postexercise alterations in cardiac function. J Appl Physiol (1985) 2023; 134:455-466. [PMID: 36656982 DOI: 10.1152/japplphysiol.00570.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The term exercise-induced cardiac fatigue (EICF) has typically been used to describe a transient reduction in cardiac function following prolonged-strenuous exercise. Recent evidence demonstrates that EICF can occur following only 45 min of high-intensity exercise when assessed using exercising stress echocardiography. This investigation sought to examine whether sprint intervals (SIT; 6 × 30 s Wingate tests), or 90-min moderate-cycling with sprint intervals (MIX; 90 min with 1 × 30 s Wingate test every 15 min) would cause greater EICF than 90 min (CON) or 3 h (LONG) moderate-cycling assessed using stress echocardiography, with a secondary aim to interrogate sex differences in EICF. Seventeen participants (M: 9, F: 8) underwent three cycling sessions with stress-echocardiography performed before-and-after each condition at a target heart rate (HR) of 100 beats·min-1, with the CON testing occurring at the mid-point of the 3 h LONG condition. For all conditions, measures of left ventricular (LV) systolic [stroke volume, ejection fraction (EF), peak longitudinal strain, isovolumetric contraction time, S') and diastolic (E/A, E', isovolumetric relaxation time, longitudinal strain rate) function were reduced after exercise (all P < 0.05). In the right ventricle (RV), systolic function was reduced (tricuspid annular plane systolic excursion, S', peak longitudinal strain and strain rate) following all conditions, and fractional area change was reduced to the greatest degree following SIT (condition × time, P = 0.01). Females demonstrated lesser impairments in LV EF, and elastance (ESP/ESV) compared with males (P < 0.05). Markers of EICF occurred similarly following all cycling loads, suggesting the functional changes may be due to altered loading conditions and reduced stress-echocardiography workload. However, males experienced greater cardiac alterations in some measures, likely due to greater changes in postexercise loading conditions.NEW & NOTEWORTHY This investigation sought to determine the role of exercise intensity on the magnitude of exercise-induced cardiac fatigue using stress echocardiography to maintain loading conditions, with a secondary purpose of assessing sex differences. Unexpectedly, it was found that all cycling loads elicited the same magnitude of functional alteration, which likely represents a common response to exercise and stress echocardiography, rather than intrinsic cardiac impairment. Males demonstrated greater alterations than females, likely due to sex differences in postexercise hemodynamics.
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Affiliation(s)
- Alexandra M Coates
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Philip J Millar
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Erevik CB, Kleiven Ø, Frøysa V, Bjørkavoll-Bergseth M, Chivulescu M, Klæboe LG, Dejgaard L, Auestad B, Skadberg Ø, Melberg T, Urheim S, Haugaa K, Edvardsen T, Ørn S. Myocardial inefficiency is an early indicator of exercise-induced myocardial fatigue. Front Cardiovasc Med 2023; 9:1081664. [PMID: 36712275 PMCID: PMC9874326 DOI: 10.3389/fcvm.2022.1081664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Background The effect of prolonged, high-intensity endurance exercise on myocardial function is unclear. This study aimed to determine the left ventricular (LV) response to increased exercise duration and intensity using novel echocardiographic tools to assess myocardial work and fatigue. Materials and methods LV function was assessed by echocardiography before, immediately, and 24 h after a cardiopulmonary exercise test (CPET) and a 91-km mountain bike leisure race. Cardiac Troponin I (cTnI) was used to assess myocyte stress. Results 59 healthy recreational athletes, 52 (43-59) years of age, 73% males, were included. The race was longer and of higher intensity generating higher cTnI levels compared with the CPET (p < 0.0001): Race/CPET: exercise duration: 230 (210, 245)/43 (40, 45) minutes, mean heart rate: 154 ± 10/132 ± 12 bpm, max cTnI: 77 (37, 128)/12 (7, 23) ng/L. Stroke volume and cardiac output were higher after the race than CPET (p < 0.005). The two exercises did not differ in post-exercise changes in LV ejection fraction (LVEF) or global longitudinal strain (GLS). There was an increase in global wasted work (p = 0.001) following the race and a persistent reduction in global constructive work 24 h after exercise (p = 0.003). Conclusion Increased exercise intensity and duration were associated with increased myocardial wasted work post-exercise, without alterations in LVEF and GLS from baseline values. These findings suggest that markers of myocardial inefficiency may precede reduction in global LV function as markers of myocardial fatigue.
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Affiliation(s)
- Christine Bjørkvik Erevik
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway,*Correspondence: Christine Bjørkvik Erevik,
| | - Øyunn Kleiven
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Vidar Frøysa
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Monica Chivulescu
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Gunnar Klæboe
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Dejgaard
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Skadberg
- Department of Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Tor Melberg
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Stig Urheim
- Department of Cardiology, Bergen University Hospital, Bergen, Norway
| | - Kristina Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stein Ørn
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Graziano F, Juhasz V, Brunetti G, Cipriani A, Szabo L, Merkely B, Corrado D, D’Ascenzi F, Vago H, Zorzi A. May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review. J Cardiovasc Dev Dis 2022; 9:jcdd9100347. [PMID: 36286299 PMCID: PMC9604467 DOI: 10.3390/jcdd9100347] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
The positive effects of physical activity are countless, not only on the cardiovascular system but on health in general. However, some studies suggest a U-shape relationship between exercise volume and effects on the cardiovascular system. On the basis of this perspective, moderate-dose exercise would be beneficial compared to a sedentary lifestyle, while very high-dose physical activity would paradoxically be detrimental. We reviewed the available evidence on the potential adverse effects of very intense, prolonged exercise on the cardiovascular system, both acute and chronic, in healthy athletes without pre-existing cardiovascular conditions. We found that endurance sports activities may cause reversible electrocardiographic changes, ventricular dysfunction, and troponin elevation with complete recovery within a few days. The theory that repeated bouts of acute stress on the heart may lead to chronic myocardial damage remains to be demonstrated. However, male veteran athletes with a long sports career show an increased prevalence of cardiovascular abnormalities such as electrical conduction delay, atrial fibrillation, myocardial fibrosis, and coronary calcifications compared to non-athletes. It must be underlined that the cause-effect relationship between such abnormalities and the exercise and, most importantly, the prognostic relevance of such findings remains to be established.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Vencel Juhasz
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Liliana Szabo
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Hajnalka Vago
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
- Correspondence: ; Tel.: +39-049-8212322
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Impact of long-lasting moderate-intensity stage cycling event on cardiac function in young female athletes: A case study. PLoS One 2022; 17:e0275332. [PMID: 36194592 PMCID: PMC9531789 DOI: 10.1371/journal.pone.0275332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Effects of intense and/or prolonged exercise have been studied extensively in male athletes. Nevertheless, data are scare on the effect of long duration events on cardiac function in female athletes. Our aim was to investigate the effect of a long-lasting moderate-intensity stage cycling event on cardiac function of young female athletes. METHODS Seven well-trained female cyclists were included. They completed a cycling event of 3529 km on 23 days. All underwent an echocardiography on 6 time-points (baseline and at the arrival of day (D) 3, 7, 12, 13 and 23). Cardiac function was assessed by conventional echocardiography, tissue Doppler imaging and speckle tracking techniques. Daily exercise load was determined by heart rate (HR), power output and rate of perceived exertion data (RPE, Borg scale). RESULTS All stages were mainly done at moderate intensity (average HR: 65% of maximal, average aerobic power output: 36% of maximal, average RPE: 4). Resting HR measured at the time of echocardiography did not vary during the event. Resting cardiac dimensions did not significantly change during the 23 days of cycling. No significant modification of cardiac function, whatever the studied cavity, were observed all along the event. CONCLUSION The results suggest that, in the context of our case study, the long-lasting moderate-intensity stage cycling event was not associated with cardiac function alteration. Nevertheless, we must be careful in interpreting them due to the limits of an underpowered study.
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Birat A, Ratel S, Dodu A, Grossoeuvre C, Dupont AC, Rance M, Morel C, Nottin S. A long duration race induces a decrease of left ventricular strains, twisting mechanics and myocardial work in trained adolescents. Eur J Sport Sci 2022:1-11. [PMID: 35757854 DOI: 10.1080/17461391.2022.2093131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND We investigated the acute cardiac consequences of a long-duration (>5 h) adventure race in adolescent athletes from evaluations of left ventricular (LV) strains and myocardial work. METHODS Twenty trained male adolescents (i.e. 8 ± 4 hours/week of endurance sports) aged 14 to 17 years participated in a competitive long-duration adventure race. Blood samples were collected before, immediately and 24 h after the race to determine the time course of troponin I (cTnI) considered as a myocardial damage biomarker. Resting echocardiography were conducted before and after the race to assess myocardial regional strains, LV twisting mechanics and myocardial work using speckle tracking echocardiography. RESULTS The mean completion time of the race was 05:38 ± 00:20 h, with a mean heart rate (HR) of 83 ± 5% of maximal HR. cTnI concentration significantly increased in 16/20 participants after the race (pre: 0.001 ± 0.002 vs. post: 0.244 ± 0.203 ng·dL-1, p < 0.001) and returned to baseline within 24 h. Stroke volume, ejection fraction and global longitudinal strains remained unchanged after the race while LV twist and global myocardial work significantly decreased (8.6 ± 3.3 vs. 6.3 ± 3.3 deg and 2080 ± 250 vs. 1781 ± 334 mmHg%, p < 0.05). Diastolic function, indexes of myocardial relaxation and LV untwisting rate (-91.0 ± 19.0 vs. -56.4 ± 29.1 deg·s-1, p < 0.001) were affected after the race. CONCLUSION We demonstrated for the first time that, in trained adolescents, a high-intensity endurance exercise of several hours induced an increase of the cTnI concentration associated with an alteration of myocardial function.
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Affiliation(s)
- Anthony Birat
- EA3533 AME2P, Université Clermont Auvergne, Clermont-Ferrand 63000, France.,Fédération Française Triathlon, Saint Denis 93210, France
| | - Sébastien Ratel
- EA3533 AME2P, Université Clermont Auvergne, Clermont-Ferrand 63000, France
| | - Alexandre Dodu
- Fédération Française Triathlon, Saint Denis 93210, France
| | | | - Anne-Charlotte Dupont
- Fédération Française Triathlon, Saint Denis 93210, France.,U1254 INSERM, Imagerie Adaptative Diagnostique et Interventionnelle (ADI), Université de Lorraine, Nancy 54510, France
| | - Mélanie Rance
- Centre de Ressources et d'Expertise de la Performance Sportive (CREPS), Bellerive-sur-Allier 03700, France
| | - Claire Morel
- Centre de Ressources et d'Expertise de la Performance Sportive (CREPS), Bellerive-sur-Allier 03700, France
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10
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Champigneulle B, Doutreleau S, Baillieul S, Brugniaux JV, Robach P, Bouzat P, Verges S. Changes in cardiac function following a speed ascent to the top of Europe at 4808 m. Eur J Appl Physiol 2022; 122:889-902. [PMID: 35103862 DOI: 10.1007/s00421-022-04895-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/18/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Both prolonged exercise and acute high-altitude exposure are known to induce cardiac changes. We sought to describe the cardiac responses to speed climbing at high-altitude, including left ventricular (LV) performance assessment using the myocardial work index (MWI), a new index derived from 2D speckle tracking echocardiography (STE). METHODS Eleven elite alpinists (9 males, age: 26 ± 4 years) were evaluated before and immediately after a speed ascent of the Mont-Blanc (4808 m) by echocardiography using conventional measurements as well as STE and MWI computation with derivate parameters as global work efficiency (GWE) or global wasted work (GWW). RESULTS Athletes performed a long-duration (8 h 58 min ± 60 min) and intense (78 ± 4% of maximal heart rate) ascent under gradual hypoxic conditions (minimal SpO2 at 4808 m: 71 ± 4%). Hypoxic exercise-induced cardiac fatigue was observed post-ascent with a change in right ventricular (RV) and LV systolic function (RV fractional area change: - 20 ± 23%, p = 0.01; LV global longitudinal strain change: - 8 ± 9%, p = 0.02), as well as LV geometry and RV-LV interaction alterations with emergence of a D-shape septum in 5/11 (46%) participants associated with RV pressure overload (mean pulmonary arterial pressure change: + 55 ± 20%, p < 0.001). Both MWI and GWE were reduced post-ascent (- 21 ± 16%, p = 0.004 and - 4 ± 4%, p = 0.007, respectively). Relative decrease in MWI and GWE were inversely correlated with increase in GWW (r = - 0.86, p = 0.003 and r = -0.97, p < 0.001, respectively). CONCLUSIONS Prolonged high-altitude speed climbing in elite climbers is associated with RV and LV function changes with a major interaction alteration. MWI, assessing the myocardial performance, could be a new tool for evaluating LV exercise-induced cardiac fatigue.
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Affiliation(s)
- Benoit Champigneulle
- HP2 laboratory, UM Sports Pathologies, Hôpital Sud, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, CS 10217, 38043 Cedex 9, Grenoble, France.
| | - Stéphane Doutreleau
- HP2 laboratory, UM Sports Pathologies, Hôpital Sud, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, CS 10217, 38043 Cedex 9, Grenoble, France
| | - Sébastien Baillieul
- HP2 laboratory, UM Sports Pathologies, Hôpital Sud, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, CS 10217, 38043 Cedex 9, Grenoble, France
| | - Julien Vincent Brugniaux
- HP2 laboratory, UM Sports Pathologies, Hôpital Sud, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, CS 10217, 38043 Cedex 9, Grenoble, France
| | - Paul Robach
- HP2 laboratory, UM Sports Pathologies, Hôpital Sud, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, CS 10217, 38043 Cedex 9, Grenoble, France
- National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - Pierre Bouzat
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Samuel Verges
- HP2 laboratory, UM Sports Pathologies, Hôpital Sud, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, CS 10217, 38043 Cedex 9, Grenoble, France
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11
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Charton M, Kervio G, Matelot D, Lachard T, Galli E, Donal E, Carré F, Le Douairon Lahaye S, Schnell F. Exercise-Induced Cardiac Fatigue in Soldiers Assessed by Echocardiography. Front Cardiovasc Med 2021; 8:785869. [PMID: 34988130 PMCID: PMC8720761 DOI: 10.3389/fcvm.2021.785869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/01/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Echocardiographic signs of exercise-induced cardiac fatigue (EICF) have been described after strenuous endurance exercise. Nevertheless, few data are available on the effects of repeated strenuous exercise, especially when associated with other constraints as sleep deprivation or mental stress which occur during military selection boot camps. Furthermore, we aimed to study the influence of experience and training level on potential EICF signs.Methods: Two groups of trained soldiers were included, elite soldiers from the French Navy Special Forces (elite; n = 20) and non-elite officer cadets from a French military academy (non-elite; n = 38). All underwent echocardiography before and immediately after exposure to several days of uninterrupted intense exercise during their selection boot camps. Changes in myocardial morphology and function of the 4 cardiac chambers were assessed.Results: Exercise-induced decrease in right and left atrial and ventricular functions were demonstrated with 2D-strain parameters in both groups. Indeed, both atrial reservoir strain, RV and LV longitudinal strain and LV global constructive work were altered. Increase in LV mechanical dispersion assessed by 2D-strain and alteration of conventional parameters of diastolic function (increase in E/e' and decrease in e') were solely observed in the non-elite group. Conventional parameters of LV and RV systolic function (LVEF, RVFAC, TAPSE, s mitral, and tricuspid waves) were not modified.Conclusions: Alterations of myocardial functions are observed in soldiers after uninterrupted prolonged intense exercise performed during selection boot camps. These alterations occur both in elite and non-elite soldiers. 2D-strain is more sensitive to detect EICF than conventional echocardiographic parameters.
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Affiliation(s)
- Marion Charton
- Department of Cardiology, Pontchaillou Hospital, Rennes, France
| | | | - David Matelot
- LTSI, INSERM, U1099, University of Rennes 1, Rennes, France
| | - Thibault Lachard
- Department of Sport Medicine, Pontchaillou Hospital, Rennes, France
| | - Elena Galli
- Department of Cardiology, Pontchaillou Hospital, Rennes, France
- LTSI, INSERM, U1099, University of Rennes 1, Rennes, France
| | - Erwan Donal
- Department of Cardiology, Pontchaillou Hospital, Rennes, France
- LTSI, INSERM, U1099, University of Rennes 1, Rennes, France
| | - François Carré
- LTSI, INSERM, U1099, University of Rennes 1, Rennes, France
- Department of Sport Medicine, Pontchaillou Hospital, Rennes, France
| | | | - Frédéric Schnell
- LTSI, INSERM, U1099, University of Rennes 1, Rennes, France
- Department of Sport Medicine, Pontchaillou Hospital, Rennes, France
- *Correspondence: Frédéric Schnell
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12
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A new perspective on cardiovascular drift during prolonged exercise. Life Sci 2021; 287:120109. [PMID: 34717912 DOI: 10.1016/j.lfs.2021.120109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
Prolonged exercise induces cardiovascular drift, which is characterized by decreasing mean arterial pressure (MAP), stroke volume and heart rate increase. Cardiovascular drift has been debated for a long time. Although the exact mechanisms underlying cardiovascular drift are still unknown, two theories have been proposed. The first is that increased skin blood flow displaces blood volume from central circulation to the periphery, which reduces stroke volume. According to this theory, the rise in heart rate is presumably responding to the drop in stroke volume and MAP. The alternative theory is that an increase in heart rate is due to an increase in sympathetic nervous activity causing reducing time at diastole, and therefore stroke volume. It may be difficult to determine a single robust factor accounting for cardiovascular drift, due to the broad range of circumstances. The primary focus of this review is to elucidate our understanding of cardiovascular drift during prolonged exercise through nitric oxide and force-frequency relationship. We highlight for the very first time that cardiovascular drift (in some conditions and within a specific time period) may be considered as a protective strategy against potential damage that could be induced by the intense and prolonged contraction of the myocardium.
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13
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Kleinnibbelink G, van Dijk AP, Fornasiero A, Speretta GF, Johnson C, Hopman MT, Sculthorpe N, George KP, Somauroo JD, Thijssen DH, Oxborough DL. Exercise-Induced Cardiac Fatigue after a 45-Minute Bout of High-Intensity Running Exercise Is Not Altered under Hypoxia. J Am Soc Echocardiogr 2021; 34:511-521. [DOI: 10.1016/j.echo.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
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14
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Coates AM, Petrick HL, Millar PJ, Burr JF. Exercise alters cardiac function independent of acute systemic inflammation in healthy men. Am J Physiol Heart Circ Physiol 2021; 320:H1762-H1773. [PMID: 33710926 DOI: 10.1152/ajpheart.00809.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute elevations in inflammatory cytokines have been demonstrated to increase aortic and left ventricular stiffness and reduce endothelial function in healthy subjects. As vascular and cardiac functions are often transiently reduced following prolonged exercise, it is possible that cytokines released during exercise may contribute to these alterations. The a priori aims of this study were to determine whether vaccine-induced increases in inflammatory cytokines would reduce vascular and left ventricular function, whether vascular alterations would drive cardiac impairments, and whether this would be potentiated by moderate exercise. In a randomized crossover fashion, 16 male participants were tested under control (CON) and inflammatory (INF) conditions, wherein INF testing occurred 8 h following administration of an influenza vaccine. On both days, participants underwent measures of echocardiography performed during light cycling (stress-echocardiography), carotid-femoral pulse wave velocity (cf-PWV), and superficial femoral flow-mediated dilation (FMD) before and after cycling for 90 min at ∼85% of their first ventilatory threshold. IL-6 increased significantly (Δ1.9 ± 1.3 pg/mL, P < 0.001), whereas TNFα was nonsignificantly augmented (Δ0.05 ± 0.11 pg/mL, P = 0.09), 8 h following vaccination. Vascular function was unaltered following cycling or inflammation (all P > 0.05). The use of echocardiography during light cycling revealed cardiac alterations traditionally expected to occur only with greater exercise loads, with reduced systolic (e.g., longitudinal strain CON: Δ3.3 ± 4.4%, INF: Δ1.7 ± 2.7%, P = 0.002) and diastolic function (e.g., E/A ratio CON: Δ-0.32 ± 0.34 a.u., INF:Δ-0.25 ± 0.27 a.u., P = 0.002) following cycling, independent of inflammation. The vaccine reduced stroke volume (SV) (main effect of condition P = 0.009) before-and-after cycling. These findings indicate that reduced cardiac function following exercise occurs largely independent of additional inflammatory load.NEW & NOTEWORHTHY This experimental investigation sought to determine the role of inflammation on the occurrence of cardiovascular alterations following exercise. Despite successfully stimulating systemic inflammation via vaccination, vascular and cardiac functions were largely unaltered. Prolonged exercise itself reduced cardiac function assessed via echocardiography performed during light exercise stress. This demonstrates a potential advantage to using stress-echocardiography for measuring exercise-induced cardiac fatigue, as typical resting measures following similar exercise exposures commonly suggest no effect.
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Affiliation(s)
- Alexandra M Coates
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Heather L Petrick
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.,Mitochondrial Metabolism Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Philip J Millar
- Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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15
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The strain and strain rate imaging paradox in echocardiography: overabundant literature in the last two decades but still uncertain clinical utility in an individual case. Arch Med Sci Atheroscler Dis 2021; 5:e297-e305. [PMID: 33644489 PMCID: PMC7885811 DOI: 10.5114/amsad.2020.103032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Almost two decades ago strain and strain rate imaging were proposed as a new, potentially more sensitive modality for quantifying both regional and global myocardial function. Until now, however, strain and strain rate imaging have been slow to be incorporated into everyday clinical practice. More recently, two dimensional strain has been claimed as of greater clinical utility, given that it is angle independent, with improved feasibility and reproducibility as compared to tissue Doppler strain. Nevertheless, speckle tracking strain is reliant on 2D image quality and frame rates. Three dimensional speckle tracking could eliminate the problem of through-plane motion inherent in 2D imaging, but 3D strain is currently limited by low frame rates. Another limitation of strain imaging is that the results are dependent on the ultrasound machine on which analyses are performed, with variability in measurements between different vendors. Despite the diagnostic and prognostic advantages of 2D strain, there is a lack of specific therapeutic interventions based on strain and a paucity of long-term large-scale randomized trial evidence on cardiovascular outcomes. After overabundant literature the same definition of normal cut-off values is controversial and not univocal. Further studies are needed, involving both manufacturers and medical professionals, on the additive contribution, possibly different case by case, of interfering and artifactual factors, aside from myocardial function per se. These artifactual determinants and motion artifacts components could be dominant in individual cases and should always be taken into account in the clinical decision making process in a single case.
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16
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Cavigli L, Zorzi A, Spadotto V, Gismondi A, Sisti N, Valentini F, Anselmi F, Mandoli GE, Spera L, Di Florio A, Baccani B, Cameli M, D'Ascenzi F. The acute effects of an ultramarathon on biventricular function and ventricular arrhythmias in master athletes. Eur Heart J Cardiovasc Imaging 2021; 23:423-430. [PMID: 33544827 DOI: 10.1093/ehjci/jeab017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/19/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Endurance sports practice has significantly increased over the last decades, with a growing proportion of participants older than 40 years. Although the benefits of moderate regular exercise are well known, concerns exist regarding the potential negative effects induced by extreme endurance sport. The aim of this study was to analyse the acute effects of an ultramarathon race on the electrocardiogram (ECG), biventricular function, and ventricular arrhythmias in a population of master athletes. METHODS AND RESULTS Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and at the end of the race. The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, R-wave amplitude in V1 and QTc duration were higher after the race (P < 0.001). Exercise-induced isolated premature ventricular beats were observed in 7% of athletes; none showed non-sustained ventricular tachycardia before or during the race. Left ventricular ejection fraction, global longitudinal strain (GLS), and twisting did not significantly differ before and after the race. After the race, no significant differences were found in right ventricular inflow and outflow tract dimensions, fractional area change, s', and free wall GLS. CONCLUSION In master endurance athletes running an ultra-marathon, exercise-induced ventricular dysfunction, or relevant ventricular arrhythmias was not detected. These results did not confirm the hypothesis of a detrimental acute effect of strenuous exercise on the heart.
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Affiliation(s)
- Luna Cavigli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Padova, Italy
| | - Veronica Spadotto
- Ospedale Riabilitativo di Alta Specializzazione, Motta di Livenza (TV), Italy
| | - Annalaura Gismondi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Niccolò Sisti
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Francesca Valentini
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Francesca Anselmi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Lucia Spera
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Alex Di Florio
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Bernardo Baccani
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
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17
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Coates AM, King TJ, Currie KD, Tremblay JC, Petrick HL, Slysz JT, Pignanelli C, Berard JA, Millar PJ, Burr JF. Alterations in Cardiac Function Following Endurance Exercise Are Not Duration Dependent. Front Physiol 2020; 11:581797. [PMID: 33071833 PMCID: PMC7531437 DOI: 10.3389/fphys.2020.581797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022] Open
Abstract
Cardiac function has been shown to transiently decrease following prolonged exercise, with greater durations related to increased impairment. However, the prospective assessment of exercise duration on cardiac performance is rare, and the influence of relative exercise intensity is typically not assessed in relation to these changes. The aim of this study was to determine whether progressively longer running distances over the same course would elicit greater cardiac impairment. The present investigation examined cardiac alterations in 49 athletes, following trail-running races of 25, 50, 80, and 160 km, performed on the same course on the same day. Echocardiography, including conventional and speckle tracking imaging, was performed with legs-raised to 60° to mitigate alterations in preload both pre- and post-race. Race-intensities were monitored via heart rate (HR). Following the races, mean arterial pressure (Δ−11 ± 7 mmHg, P < 0.0001), and HR (Δ19 ± 14 bpm, P < 0.0001) were altered independent of race distance. Both left and right ventricular (LV and RV) diastolic function were reduced (ΔLV E/A −0.54 ± 0.49, P < 0.0001; ΔRV A’ + 0.02 ± 0.04 m/s, P = 0.01) and RV systolic function decreased (ΔTAPSE −0.25 ± 0.9 cm, P = 0.01), independent of race distance. Cardiac impairment was not apparent using speckle tracking analysis with cubic spline interpolation. While race duration was unrelated to cardiac alterations, increased racing HR was related to greater RV base dilation (r = −0.37, P = 0.03). Increased time spent at higher exercise intensities was related to reduced LV ejection fraction following 25 km (r = −0.81, P = 0.03), LV systolic strain rate following 50 km (r = 0.59, P = 0.04), and TAPSE (r = −0.81, P = 0.03) following 80 km races. Increased running duration did not affect the extent of exercise-induced cardiac fatigue, however, intensity may be a greater driver of cardiac alterations.
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Affiliation(s)
- Alexandra M Coates
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Trevor J King
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Katharine D Currie
- Exercise and Cardiovascular Health Outcomes Laboratory, Department of Kinesiology, Michigan State University, East Lansing, MI, United States
| | - Joshua C Tremblay
- Cardiovascular Stress Response Laboratory, Queen's University, Kingston, ON, Canada
| | - Heather L Petrick
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Joshua T Slysz
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Christopher Pignanelli
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Jordan A Berard
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Philip J Millar
- Cardiovascular Physiology Laboratory, Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Jamie F Burr
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
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18
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Factors Related to Cardiac Troponin T Increase after Participation in a 100 Km Ultra-Marathon. Diagnostics (Basel) 2020; 10:diagnostics10030167. [PMID: 32204320 PMCID: PMC7151175 DOI: 10.3390/diagnostics10030167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Intensive and prolonged exercise leads to a rise of troponin concentration in blood. The mechanism responsible for troponin release during exercise remains ill-defined. The study aim was to search for risk factors of troponin increase after a prolonged endurance competition. METHODS The study included a group of 18 amateurs, healthy volunteers (median age 41.5 years, interquartile range - IQR 36-53 years, 83% male) who participated in a 100 km running ultra-marathon. Information on demographic characteristics, pre- and post-race heart rate, blood pressure, body composition and glucose, lactate (L), troponin T (hs-TnT) and C reactive protein (hs-CRP) concentration were obtained. Additionally, data on L and glucose levels every 9.2 km and fluid/food intakes during the race were collected. RESULTS There was a significant hs-TnT increase after the race exceeding upper reference values in 66% of runners (from 5 IQR 3-7 ng/L to 14 IQR 12-26 ng/L, p < 0.0001). None of the baseline parameters predicted a post-race hs-TnT increase. The only factors, correlating with changes of hs-TnT were mean L concentration during the race (rho = 0.52, p = 0.03) and change of hs-CRP concentration (rho = 0.59, p = 0.01). CONCLUSIONS Participation in a 100 km ultra-marathon leads to a modest, but significant hs-TnT increase in the majority of runners. Among analysed parameters only mean lactate concentration during the race and change in hs-CRP correlated with troponin change.
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Abstract
This short review offers a general summary of the consequences of whole body exercise on neuromuscular fatigue pertaining to the locomotor musculature. Research from the past two decades have shown that whole body exercise causes considerable peripheral and central fatigue. Three determinants characteristic for locomotor exercise are discussed, namely, pulmonary system limitations, neural feedback mechanisms, and mental/psychological influences. We also discuss existing data suggesting that the impact of whole body exercise is not limited to locomotor muscles, but can also impair non-locomotor muscles, such as respiratory and cardiac muscles, and other limb muscles not directly contributing to the task.
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Affiliation(s)
- Joshua C Weavil
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, Salt Lake City, UT
| | - Markus Amann
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, Salt Lake City, UT.,Department of Anesthesiology, University of Utah, Salt Lake City, UT
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20
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Oosthuyse T, Bosch AN, Millen AME. Effect of ingesting carbohydrate only or carbohydrate plus casein protein hydrolysate during a multiday cycling race on left ventricular function, plasma volume expansion and cardiac biomarkers. Eur J Appl Physiol 2019; 119:697-711. [PMID: 30610443 DOI: 10.1007/s00421-018-04060-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/18/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE Multiday racing causes mild left ventricular (LV) dysfunction from day 1 that persists on successive days. We evaluated ingesting casein protein hydrolysate-carbohydrate (PRO) compared with carbohydrate-only (CHO) during a 3-day mountain bike race. METHODS Eighteen male cyclists were randomly assigned to ingest 6.7% carbohydrate without (CHO) or with 1.3% casein hydrolysate (PRO) during racing (~ 4-5 h/day; 68/71/71 km). Conventional LV echocardiography, plasma albumin content, plasma volume (PV) and blood biomarkers were measured before day 1 and post race on day 3. RESULTS Fourteen cyclists (n = 7 per group) completed the race. PV increased in CHO (mean increase (95% CI), 10.2% (0.1 to 20.2)%, p = 0.045) but not in PRO (0.4% (- 6.1 to 6.9)%). Early diastolic transmitral blood flow (E) was unchanged but deceleration time from peak E increased post race (CHO: 46.7 (11.8 to 81.6) ms, p = 0.019; PRO: 24.2 (- 0.5 to 48.9) ms, p = 0.054), suggesting impaired LV relaxation. Tissue Doppler mitral annular velocity was unchanged in CHO, but in PRO septal early-to-late diastolic ratio decreased (p = 0.016) and was compensated by increased lateral early (p = 0.034) and late (p = 0.012) velocities. Systolic function was preserved in both groups; with increased systolic lateral wall velocity in PRO (p = 0.002). Effect size increase in serum creatine kinase (CK) activity, CK-MB and C-reactive protein concentrations was less in PRO than CHO (Cohen's d mean ± SD, PRO: 2.91 ± 2.07; CHO: 7.56 ± 4.81, p = 0.046). CONCLUSION Ingesting casein hydrolysate with carbohydrate during a 3-day race prevented secondary hypervolemia and failed to curb impaired LV relaxation despite reducing tissue damage and inflammatory biomarkers. Without PV expansion, systolic function was preserved by lateral wall compensating for septal wall dysfunction.
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Affiliation(s)
- Tanja Oosthuyse
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Medical School, 7 York Road, Parktown, 2193, South Africa.
| | - Andrew N Bosch
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Aletta M E Millen
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Medical School, 7 York Road, Parktown, 2193, South Africa
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