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The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

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Abstract

Purpose

There is contradictory evidence related to the impact of ultra-marathon running on right ventricular (RV) structure and function. Consequently, the aims of this study were to: (1) comprehensively assess RV structure and function before and immediately following a 100-mile ultra-marathon in highly trained runners, (2) determine the nature of RV recovery 6 h post-race, and (3) document 12-lead electrocardiogram (ECG) changes post-exercise.

Methods

Echocardiography and 12-lead ECG were assessed in 15 competitors in a repeated measures design before and immediately after completion of the 2013 Western States Endurance Race. A subset of nine was reassessed 6 h into recovery. Standard echocardiography was used to determine RV size, function and wall stress. Myocardial speckle tracking (MST) provided peak, time to peak and temporal indices for RV longitudinal strain and strain rates (ε and SR).

Results

RV size was increased post-race (inflow tract 14 %, outflow tract 11 %, P = 0.004 and 0.002). RV wall stress was elevated by 11 % post-race. Peak RV ε was reduced by 10 % (P = 0.007) and significantly delayed post-race (P = 0.008). Most changes in RV function persisted at the 6-h assessment. Post-race there was an increase in the prevalence of right-sided ECG changes.

Conclusions

Completion of a 100-mile ultra-marathon resulted in acute changes in RV structure and function that persisted 6 h into recovery and are consistent with sustained exposure to an elevated RV wall stress. These findings were supported by right-sided changes to the 12-lead ECG.

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Abbreviations

A′:

Late diastolic myocardial tissue velocity

AP4CH:

Apical 4 chamber view

ASE:

American Society of Echocardiography

E′:

Early diastolic myocardial tissue velocity

ECG:

Electrocardiogram

EI:

Eccentricity index

EICF:

Exercise-induced cardiac fatigue

FAC:

Fractional area change

HR:

Heart rate

IVCT:

Isovolumic contraction time

IVRT:

Isovolumic relaxation time

LV:

Left ventricle

MST:

Myocardial speckle tracking

PASP:

Pulmonary artery systolic pressure

PLAX:

Parasternal long axis view

PSAX:

Parasternal short axis view

PW:

Pulsed wave

RA:

Right atrium

RAD:

Right axis deviation

RV:

Right ventricle

RVAs:

Right ventricular systolic area

RVH:

Right ventricular hypertrophy

RVOT:

Right ventricular outflow tract

RVSp:

Right ventricular systolic pressure

S′:

Systolic myocardial tissue velocity

ε :

Myocardial strain

SRA:

Late diastolic strain rate

SRE:

Early diastolic strain rate

SRS:

Systolic strain rate

SV:

Stroke volume

TDI:

Tissue Doppler imaging

T sPeak:

Time to peak strain

T SRAPeak:

Time to peak late diastolic strain rate

T SREPeak:

Time to peak early diastolic strain rate

T SRSPeak:

Time to peak systolic strain rate

TVI:

Tissue velocity imaging

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Acknowledgments

We would like to thank the Western States Endurance Run Foundation for their support with this study.

Conflict of interest

None.

Ethical standards

Ethics approval was granted by the Liverpool John Moores Ethics committee and the study complied with the current laws of the USA where the research was undertaken.

Author information

Authors and Affiliations

  1. Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK

    Rachel Lord, John Somauroo, Keith George, Helen Jones & David Oxborough

  2. Countess of Chester Hospital, NHS Trust, Chester, UK

    John Somauroo

  3. Cardiff School of Sport, Cardiff Metropolitan University, Llandaff Campus, Cardiff, UK

    Mike Stembridge & Rob Shave

  4. Stanford University School of Medicine, Falk Cardiovascular Research Center, Stanford, CA, USA

    Nikhil Jain, Francois Haddad & Euan Ashley

  5. Departments of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA

    Martin D. Hoffman

  6. Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, USA

    Martin D. Hoffman

Authors
  1. Rachel Lord
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  2. John Somauroo
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  3. Mike Stembridge
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  4. Nikhil Jain
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  5. Martin D. Hoffman
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  6. Keith George
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  7. Helen Jones
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  8. Rob Shave
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  9. Francois Haddad
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  10. Euan Ashley
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  11. David Oxborough
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Corresponding author

Correspondence to Rachel Lord.

Additional information

Communicated by Carsten Lundby.

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Lord, R., Somauroo, J., Stembridge, M. et al. The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography. Eur J Appl Physiol 115, 71–80 (2015). https://doi.org/10.1007/s00421-014-2995-6

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  • DOI: https://doi.org/10.1007/s00421-014-2995-6

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