The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography
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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.
KeywordsEndurance Exercise Ultrasound Running Cardiology physiology
Late diastolic myocardial tissue velocity
Apical 4 chamber view
American Society of Echocardiography
Early diastolic myocardial tissue velocity
Exercise-induced cardiac fatigue
Fractional area change
Isovolumic contraction time
Isovolumic relaxation time
Myocardial speckle tracking
Pulmonary artery systolic pressure
Parasternal long axis view
Parasternal short axis view
Right axis deviation
Right ventricular systolic area
Right ventricular hypertrophy
Right ventricular outflow tract
Right ventricular systolic pressure
Systolic myocardial tissue velocity
Late diastolic strain rate
Early diastolic strain rate
Systolic strain rate
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
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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