Objective There is evidence that ultra-endurance exercise causes myocardial injury. The extent and duration of these changes remains unresolved. Recent reports speculate that structural adaptations to exercise, particularly of the right ventricle (RV), may predispose to tachyarrhythmias and sudden cardiac death. This study aimed to quantify the extent and duration of post-exercise cardiac injury with particular attention to right ventricular (RV) dysfunction.
Methods We tested 27 athletes (20 male, 7 female) one week before, immediately after, and one week following an ultra-endurance triathlon. Tests included cardiac troponin I (cTnI), B-type natriuretic peptide (BNP) and comprehensive echocardiographic assessment.
Results 26 athletes completed the race and testing procedures. Post-race, cTnI was elevated in 15 athletes (56%) and the mean value for the entire cohort increased (0.17 vs 0.49µg/L, p<0.01). BNP rose in every athlete and the mean increased significantly (12.2 vs 42.5 ηg/L, p<0.001). Left ventricular ejection fraction (LVEF) was unchanged (60.4 vs 57.5%, p=0.09), but integrated systolic strain decreased (16.9% vs 15.1%, p<0.01). New regional wall motion abnormalities developed in 7 athletes (27%) and LVEF was reduced in this sub-group (57.8% vs 45.9%, p<0.001). RV function was reduced in the entire cohort with decreases in fractional area change (0.47 vs 0.39, p<0.01) and tricuspid annular plane systolic excursion (21.7 vs 19.1mm, p<0.01). At follow-up, all parameters returned to baseline except for one athlete with persisting RV dysfunction.
Conclusion Myocardial damage occurs during intense ultra-endurance exercise and, in particular, there is a significant reduction in RV function. Almost all abnormalities resolve within 1 week.
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