European Journal of Applied Physiology

, Volume 115, Issue 1, pp 71–80 | Cite as

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

  • Rachel Lord
  • John Somauroo
  • Mike Stembridge
  • Nikhil Jain
  • Martin D. Hoffman
  • Keith George
  • Helen Jones
  • Rob Shave
  • Francois Haddad
  • Euan Ashley
  • David Oxborough
Original Article



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.


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).


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.


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.


Endurance Exercise Ultrasound Running Cardiology physiology 



Late diastolic myocardial tissue velocity


Apical 4 chamber view


American Society of Echocardiography


Early diastolic myocardial tissue velocity




Eccentricity index


Exercise-induced cardiac fatigue


Fractional area change


Heart rate


Isovolumic contraction time


Isovolumic relaxation time


Left ventricle


Myocardial speckle tracking


Pulmonary artery systolic pressure


Parasternal long axis view


Parasternal short axis view


Pulsed wave


Right atrium


Right axis deviation


Right ventricle


Right ventricular systolic area


Right ventricular hypertrophy


Right ventricular outflow tract


Right ventricular systolic pressure


Systolic myocardial tissue velocity


Myocardial strain


Late diastolic strain rate


Early diastolic strain rate


Systolic strain rate


Stroke volume


Tissue Doppler imaging


Time to peak strain


Time to peak late diastolic strain rate


Time to peak early diastolic strain rate


Time to peak systolic strain rate


Tissue velocity imaging



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

Conflict of interest


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.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Rachel Lord
    • 1
  • John Somauroo
    • 1
    • 2
  • Mike Stembridge
    • 3
  • Nikhil Jain
    • 4
  • Martin D. Hoffman
    • 5
    • 6
  • Keith George
    • 1
  • Helen Jones
    • 1
  • Rob Shave
    • 3
  • Francois Haddad
    • 4
  • Euan Ashley
    • 4
  • David Oxborough
    • 1
  1. 1.Research Institute for Sport and Exercise Sciences, Tom Reilly BuildingLiverpool John Moores UniversityLiverpoolUK
  2. 2.Countess of Chester Hospital, NHS TrustChesterUK
  3. 3.Cardiff School of SportCardiff Metropolitan UniversityCardiffUK
  4. 4.Stanford University School of Medicine, Falk Cardiovascular Research CenterStanfordUSA
  5. 5.Departments of Physical Medicine and RehabilitationUniversity of California Davis Medical CenterSacramentoUSA
  6. 6.Department of Veterans AffairsNorthern California Health Care SystemSacramentoUSA

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