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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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Jouffroy R, Hergault H, Antero J, Vieillard Baron A, Mansencal N. Relationship between echocardiographic characteristics and cardiac biomarkers during long-distance trail running. Front Cardiovasc Med 2022; 9:954032. [PMID: 36051277 PMCID: PMC9424639 DOI: 10.3389/fcvm.2022.954032] [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: 05/26/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Even if the beneficial cardiovascular effects of moderate exercise are recognized, effects of prolonged and intense exercise are still debated. This study aims to detect cardiovascular changes associated with long endurance running by assessing the relationship between echocardiographic parameters and cardiac biomarkers during long-distance trail running. Methods We performed a prospective observational study that included 20 participants who were all amateur runners (median age of 41 years old, still alive after a 7-year clinical follow-up) from 80-km trail running. All the participants underwent an echocardiographic examination and venous blood sampling before the race, at the intermediate refreshment checkpoints of the race (21st and 53rd km), and within 10 min after arrival. Results Mitral E/A velocity ratio and mitral TDI e’ wave were significantly decreased at the 21st km to arrival (p < 0.05). Mitral S wave and global longitudinal strain (GLS) were significantly decreased from the 53rd km to arrival (p < 0.05 for 53rd and 80th km). As compared to baseline, T-troponin and NT-proBNP were significantly increased at the 21st km in all the participants, but T-troponin values were systematically increased above the significative threshold. Diastolic echocardiographic abnormalities were mainly observed among participants with highest NT-proBNP (> 77 ng.l–1) values at the 21st km. As compared to baseline, mitral e’ wave was significantly decreased (–35%) in participants with highest values of NT-proBNP. Similarly, GLS was also depressed among participants with highest troponin values at the 53rd km (p = 0.01 for 53rd km and p = 0.04 for arrival). Conclusion During the long-distance trail running, the early LV decrease in diastolic echocardiographic parameters is associated with increase in NT pro-BNP blood levels, and the decrease in LV systolic echocardiographic parameters later is associated with increase in T-troponin blood levels.
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Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique—Hôpitaux de Paris (AP-HP), Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
- IRMES - Institute for Research in Medicine and Epidemiology of Sport, INSEP, Paris, France
- INSERM U-1018, CESP, Clinical Epidemiology, Université de Versailles-Saint Quentin (UVSQ), Villejuif, France
- *Correspondence: Romain Jouffroy,
| | - Hélène Hergault
- INSERM U-1018, CESP, Clinical Epidemiology, Université de Versailles-Saint Quentin (UVSQ), Villejuif, France
- Department of Cardiology, Ambroise Paré Hospital, AP-HP, Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Juliana Antero
- IRMES - Institute for Research in Medicine and Epidemiology of Sport, INSEP, Paris, France
| | - Antoine Vieillard Baron
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique—Hôpitaux de Paris (AP-HP), Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
- INSERM U-1018, CESP, Clinical Epidemiology, Université de Versailles-Saint Quentin (UVSQ), Villejuif, France
| | - Nicolas Mansencal
- INSERM U-1018, CESP, Clinical Epidemiology, Université de Versailles-Saint Quentin (UVSQ), Villejuif, France
- Department of Cardiology, Ambroise Paré Hospital, AP-HP, Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
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3
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Valenzuela PL, Baggish A, Castillo-García A, Santos-Lozano A, Boraita A, Lucia A. Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations. Compr Physiol 2022; 12:4067-4085. [PMID: 35950659 DOI: 10.1002/cphy.c210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although the benefits of regular physical activity on cardiovascular health are well established, the effects of strenuous endurance exercise (SEE) have been a matter of debate since ancient times. In this article, we aim to provide a balanced overview of what is known about SEE and the heart-from epidemiological evidence to recent cardiac imaging findings. Lifelong SEE is overall cardioprotective, with endurance master athletes showing in fact a youthful heart. Yet, some lines of research remain open, such as the need to elucidate the time-course and potential relevance of transient declines in heart function (or increases in biomarkers of cardiac injury) with SEE. The underlying mechanisms and clinical relevance of SEE-associated atrial fibrillation, myocardial fibrosis, or high coronary artery calcium scores also remain to be elucidated. © 2022 American Physiological Society. Compr Physiol 12:1-19, 2022.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adrián Castillo-García
- Fissac - Physiology, Health and Physical Activity, Madrid, Spain.,Biology Systems Department, University of Alcalá, Madrid, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.,i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain
| | - Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Spanish Agency for Health Protection in Sports, Madrid, Spain
| | - Alejandro Lucia
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.,Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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Ricci F, Aquaro GD, De Innocentiis C, Rossi S, Mantini C, Longo F, Khanji MY, Gallina S, Pingitore A. Exercise-induced myocardial edema in master triathletes: Insights from cardiovascular magnetic resonance imaging. Front Cardiovasc Med 2022; 9:908619. [PMID: 35983187 PMCID: PMC9378862 DOI: 10.3389/fcvm.2022.908619] [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: 03/30/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Strenuous exercise has been associated with functional and structural cardiac changes due to local and systemic inflammatory responses, reflecting oxidative, metabolic, hormonal, and thermal stress, even in healthy individuals. We aimed to assess changes in myocardial structure and function using cardiovascular magnetic resonance (CMR) imaging in master triathletes early after a full-distance Ironman Triathlon race. Materials and methods Ten master triathletes (age 45 ± 8 years) underwent CMR within 3 h after a full-distance Ironman Triathlon race (3.8 km swimming, 180 km cycling, and 42.2 km running) completed with a mean time of 12 ± 1 h. All the triathletes had a 30-day follow-up CMR. Cine balanced steady-state free precession, T2-short tau inversion recovery (STIR), tagging, and late gadolinium enhancement (LGE) imaging sequences were performed on a 1.5-T MR scanner. Myocardial edema was defined as a region with increased T2 signal intensity (SI) of at least two SDs above the mean of the normal myocardium. The extent of myocardial edema was expressed as the percentage of left ventricular (LV) mass. Analysis of LV strain and torsion by tissue tagging included the assessment of radial, longitudinal, and circumferential peak systolic strain, rotation, and twist. Results Compared with postrace, biventricular volumes, ejection fraction, and LV mass index remained unchanged at 30-day follow-up. Global T2 SI was significantly higher in the postrace CMR (postrace 10.5 ± 6% vs. follow-up 3.9 ± 3.8%, P = 0.004) and presented with a relative apical sparing distribution (P < 0.001) matched by reduction of radial peak systolic strain of basal segments (P = 0.003). Apical rotation and twist were significantly higher immediately after the competition compared with follow-up (P < 0.05). Conclusion Strenuous exercise in master triathletes is associated with a reversible regional increase in myocardial edema and reduction of radial peak systolic strain, both presenting with a relative apical sparing pattern.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
- *Correspondence: Fabrizio Ricci,
| | | | - Carlo De Innocentiis
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Serena Rossi
- Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - Mohammed Y. Khanji
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
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Echocardiographic Assessment of Left Ventricular Function 10 Years after the Ultra-Endurance Running Event Eco-Trail de Paris® 2011. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148268. [PMID: 35886119 PMCID: PMC9318254 DOI: 10.3390/ijerph19148268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
Abstract
Background: Regular and moderate physical activity is beneficial for physical and mental health, resulting in an increase in life expectancy for both sexes. From a cardiovascular point of view, although the benefits of regular moderate physical exercise have been established, the long-term effects of repeated ultra-endurance running events are still unknown. Hypothesis: The aim of our study is to evaluate the 10-year evolution of the parameters of the left ventricular systolic and diastolic functions of amateur subjects regularly practising ultra-endurance running events using resting echocardiography. Study design: Cross-sectional study. Level of evidence: Level 3—non-randomized controlled cohort/follow-up study. Methods: The 66 participants who participated in the 2011 edition of the Eco-Trail de Paris® were contacted by e-mail. Demographic data, sports practice, and the results of an echocardiography scan carried out during the year 2021 evaluating left ventricular systolic and diastolic function variables were collected. Echographic variables from 2011 and 2021 were compared using the paired Student’s t-test. Results: Forty-six (70%) participants responded positively. Twenty (30%) participants could not be reached and were not analysed. Of the 46 respondents, 42 (91%) provided data from a trans-thoracic cardiac ultrasound performed in 2021. Over the past 10 years, the participants reported having completed an average of 4 ± 2 ultra-trails per year. No significant differences were observed between left ventricular diastolic and systolic echocardiographic parameters between the years 2011 and 2021. Conclusions: Among amateur participants, long-distance running is not associated with an alteration in the echocardiographic parameters of resting left ventricular systolic and diastolic function after 10 years of practice. Clinical relevance: Long-term long-distance running practice is not associated with left ventricular cardiac function alteration. These results suggest a potential adaptation role of the cardiovascular system to regular and moderate long-distance running practice.
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Wolff S, Picco JM, Díaz-González L, Valenzuela PL, Gonzalez-Dávila E, Santos-Lozano A, Matile P, Wolff D, Boraita A, Lucia A. Exercise-Induced Cardiac Fatigue in Recreational Ultramarathon Runners at Moderate Altitude: Insights From Myocardial Deformation Analysis. Front Cardiovasc Med 2022; 8:744393. [PMID: 35141287 PMCID: PMC8818846 DOI: 10.3389/fcvm.2021.744393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Controversy exists on the actual occurrence of exercise-induced cardiac fatigue (EICF) with ultraendurance exercise, as well as on whether factors such as age or training status might predispose to this condition. The present study aimed to assess the occurrence of EICF among recreational ultramarathon runners, as well as to determine potential predictive factors. Methods Nineteen male recreational runners (42 ± 12yrs) participated in a 55-km trial race at moderate altitude (1,800–2,500 m). Participants were evaluated before and after the race using Doppler echocardiography and myocardial deformation analysis. EICF was determined as a reduction >5% of either left ventricular global longitudinal strain (LVGLS) or right ventricular free wall strain (RVFWS). Demographical (age, body mass index), training (training experience, volume and intensity), competition (finishing time, relative intensity) and biochemical variables (blood lactate, creatine kinase [CK] and CK-MB) were assessed as predictors of EICF. Results A significant reduction in LVGLS (20.1 ± 2.1% at baseline vs. 18.8 ± 2.4% at post-race, p = 0.026), but not in RVFWS (27.4 ± 7.0 vs. 24.6 ± 5.3%, p = 0.187), was observed after the race. EICF was present in 47 and 71% of the participants attending to the decrease in LVGLS and RVFWS, respectively. No associations were found between any of the analyzed variables and EICF except for age, which was associated with the magnitude of decrement of RVFWS (r = 0.58, p = 0.030). Conclusions Ultramarathon running at moderate altitude seems to induce EICF in a considerable proportion of recreational athletes.
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Affiliation(s)
- Sebastián Wolff
- Wolff Cardiology and Sport Medicine Institute, Mendoza, Argentina
| | - José M. Picco
- Wolff Cardiology and Sport Medicine Institute, Mendoza, Argentina
| | - Leonel Díaz-González
- Cardiology Department, CEMTRO Clinic, Madrid, Spain
- Cardiology Department, La Paz Hospital, Madrid, Spain
| | - Pedro L. Valenzuela
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Physical Activity and Health Research Group (“PaHerg”), Research Institute of the Hospital 12 de Octubre (“Imas12”), Madrid, Spain
| | | | - Alejandro Santos-Lozano
- I+HeALTH, European University Miguel de Cervantes, Valladolid, Spain
- Physical Activity and Health Research Group (“PaHerg”), Research Institute of the Hospital 12 de Octubre (“Imas12”), Madrid, Spain
| | | | - David Wolff
- Wolff Cardiology and Sport Medicine Institute, Mendoza, Argentina
| | - Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Spanish Sports Health Protection Agency, Consejo Superior de Deportes, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Physical Activity and Health Research Group (“PaHerg”), Research Institute of the Hospital 12 de Octubre (“Imas12”), Madrid, Spain
- *Correspondence: Alejandro Lucia
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Calleja-Romero A, Vicente-Rodríguez G, Garatachea N. Acute effects of long-distance races on heart rate variability and arterial stiffness: A systematic review and meta-analysis. J Sports Sci 2021; 40:248-270. [PMID: 34720045 DOI: 10.1080/02640414.2021.1986276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study systematically reviewed and quantified the effects of running a long-distance race (LDR) on heart rate variability (HRV) and arterial stiffness (AS). All types of races of a distance equal to or greater than a marathon (≥42.2 km) were included. A total of 2,220 articles were identified, 52 were included in the qualitative analysis, and 48 were meta-analysed. The standardised mean difference pre- and post-race of various time-domain and frequency-domain indices of HRV, mean arterial blood pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP) and carotid-femoral pulse wave velocity (cfPWV) was calculated. Regarding HRV, there was a significant decrease in most of the variables considered as markers of parasympathetic activity, indicating a shift of autonomic balance towards a reduced vagal tone. Regarding vascular variables, there was a significant drop in blood pressure and reduced AS. In conclusion, running an LDR seems to have a considerable acute effect on the autonomic nervous system, haemodynamics, and vascular properties. The observed effects could be categorised within the expected acute responses to long-lasting, strenuous exercise.
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Affiliation(s)
- Alberto Calleja-Romero
- Faculty of Health and Sport Science (Fcsd, Ronda Misericordia 5, 22001-Huesca, Spain), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain
| | - Germán Vicente-Rodríguez
- Faculty of Health and Sport Science (Fcsd, Ronda Misericordia 5, 22001-Huesca, Spain), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain.,Growth, Exercise, Nutrition and Development Group and IIS-Aragon, Spain.,Centro De Investigación Biomédica En Red De Fisiopatología De La Obesidad Y Nutrición (Ciber-obn), Madrid, Spain.,Instituto Agroalimentario De Aragón -ia2- (Cita-universidad De Zaragoza), Zaragoza, Spain
| | - Nuria Garatachea
- Faculty of Health and Sport Science (Fcsd, Ronda Misericordia 5, 22001-Huesca, Spain), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain.,Growth, Exercise, Nutrition and Development Group and IIS-Aragon, Spain.,Centro De Investigación Biomédica En Red De Fisiopatología De La Obesidad Y Nutrición (Ciber-obn), Madrid, Spain.,Instituto Agroalimentario De Aragón -ia2- (Cita-universidad De Zaragoza), Zaragoza, Spain
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Liu CH, Li LH, Chang ML, Kao WF, How CK, Lai JI, Lin YK, Chiu YH, Chang WH. Electrical Cardiometry and Cardiac Biomarkers in 24-h and 48-h Ultramarathoners. Int J Sports Med 2021; 42:1035-1042. [PMID: 33690866 DOI: 10.1055/a-1380-4219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Our study aimed to (i) utilize novel electrical cardiometry and observe acute changes in cardiac biomarkers among 24-h and 48-h ultra-marathoners, and (ii) examine whether alterations in cardiac responses were associated with the average running speed of these participants. Twenty-four 24-h and sixteen 48-h ultra-marathoners were recruited. Electrical cardiometry in the 2 groups showed significant post-race drops in systolic pressure (24-h: p=0.001; 48-h: p=0.016) and rapid increases in heart rate (24-h, p=0.004; 48-h, p=0.001). Cardiac output increased in 48-h runners (p=0.012) and stroke volume decreased in 24-h runners (p=0.009) at post-test. Six of 20 (30%) 24-h and 4 of 16 (25%) 48-h runners had high-sensitivity troponin T values above the reference interval after the races. N-terminal proB-type natriuretic peptide levels showed a 15-fold increase in 24-h runners and a 10-fold increase in 48-h runners at post-race. There was a positive correlation between delta N-terminal proB-type natriuretic peptide and running mileage (rs=0.629, p=0.003) in 24-h ultra-marathoners. In conclusion, stroke volume and cardiac output showed inconsistent changes between the 2 groups. Average running speed has a significant effect on post-exercise elevation in cardiac biomarkers.
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Affiliation(s)
- Che-Hung Liu
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Li-Hua Li
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ming-Long Chang
- Department of Emergency & Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Fong Kao
- Department of Emergency & Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Ministry of Health and Welfare, Kinmen Hospital, Kinmen, Taiwan
| | - Jiun-I Lai
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Kuang Lin
- Big Data Research Center, Taipei Medical University, Taipei, Taiwan.,Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hui Chiu
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Han Chang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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9
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Franzoni L. Caminhada de Longa Duração pode Alterar Biomarcadores Cardíacos e Variáveis Ecocardiográficas Relacionadas à Função Diastólica? Arq Bras Cardiol 2020; 115:628-629. [PMID: 33111859 PMCID: PMC8386973 DOI: 10.36660/abc.20200457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Euzebio MB, Vitorino PVDO, Sousa WM, Melo MA, Costa SHN, Sousa ALL, Jardim TDSV, Arantes AC, Jardim PCBV, Barroso WKS. Diastolic Function and Biomarkers of Long-Distance Walking Participants. Arq Bras Cardiol 2020; 115:620-627. [PMID: 33111858 PMCID: PMC8386974 DOI: 10.36660/abc.20190271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/07/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effects of long-distance walking on the cardiovascular system have been little studied. OBJECTIVES The general objective of this study was to verify these effects on the behavior of diastolic function and the cardiac biomarkers CK-MB (mass), troponin T, and NT-proBNP, in amateur athletes. METHOD This longitudinal study, conducted in 2015, evaluated participants during the following 5 stages: E0 (baseline) before starting the trajectory and the others, E1, E2, E3, and E4, at the end of each day, totaling 244.7 km. At all stages, the biomarkers NT-proBNP, CK-MB (mass), and troponin T were measured. Echocardiogram was performed to analyze the E, A and E' waves. P < 0.05 was adopted as significant. RESULTS The study evaluated 25 participants, with an average age of 46 ± 10.5 years and body mass index of 20.2 ± 2.3 kg/m2. Increased values were found for NT-proBNP from E0 to E1, E2, E3, and E4 (p < 0.001), CK-MB (mass) from E0 to E2 (p < 0.001), and E' wave from E0 to E1, E2, E3, and E4 (p < 0.001). Positive correlations were identified between the following: CK-MB (mass) and troponin T (E1: r = 0.524, p = 0.010; E4: r = 0.413, p = 0.044); CK-MB (mass) and NT-proBNP (E4: r = 0.539, p = 0.006); and E/A and E' (E0: r = 0.603, p < 0.001; E1: r = 0.639, p < 0.001; E4: r = 0.593, p = 0.002). A negative correlation was found between CK-MB (mass) and E/A (E1: r = -0.428, p = 0.041). CONCLUSION The effects of intense, prolonged, and interspersed physical activity were verified based on significant variations in the behavior of CK-MB (mass), NT-proBNP, and the E' wave. Notwithstanding the alterations found, there were no criteria suggestive of myocardial damage.
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Affiliation(s)
- Maicon Borges Euzebio
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Medicina, Goiânia, GO – Brasil
- Pontifícia Universidade Católica de GoiásGoiâniaGOBrasilPontifícia Universidade Católica de Goiás, Goiânia, GO – Brasil
| | | | - Watila Moura Sousa
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Medicina, Goiânia, GO – Brasil
| | - Milena Andrade Melo
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Pós-graduação em Ciências da Saúde, Goiânia, GO – Brasil
| | - Sérgio Henrique Nascente Costa
- Pontifícia Universidade Católica de GoiásGoiâniaGOBrasilPontifícia Universidade Católica de Goiás, Goiânia, GO – Brasil
- Faculdade da Polícia Militar do Estado de GoiásGoiâniaGOBrasilFaculdade da Polícia Militar do Estado de Goiás, Goiânia, GO - Brasil
| | - Ana Luiza Lima Sousa
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Pós-graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Thiago de Souza Veiga Jardim
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Pós-graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Ana Carolina Arantes
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Pós-graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Paulo Cesar B. Veiga Jardim
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Cardiologia, Goiânia, GO – Brasil
| | - Weimar Kunz Sebba Barroso
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Pós-graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás – Liga de Hipertensão Arterial, Goiânia, GO – Brasil
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11
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Sengupta S, Jain R, Burkule N, Olet S, Khandheria BK. Myocardial Work Index: A Novel Method for Assessment of Myocardial Function in South Asian Recreational Athletes. J Patient Cent Res Rev 2020; 7:147-156. [PMID: 32377548 DOI: 10.17294/2330-0698.1730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose We used a novel noninvasive method based on speckle-tracking echocardiography to evaluate myocardial performance in South Asian recreational athletes who completed a half marathon. Methods Transthoracic echocardiography was performed on 24 recreational athletes 48 hours before they took part in a half marathon (premarathon), within 2 hours of half marathon completion (postmarathon), and 72 hours after completion. Clinical, laboratory, and echocardiographic variables were collected. Speckle-tracking echocardiography was performed in all subjects to characterize myocardial mechanics. Results Mean age of participants was 41.8 ± 7.4 years, and 23 (95.8%) were male. No subject had a prior history of coronary artery disease. Significant changes in pre- and postmarathon values suggested myocardial injury, including an increase in mean brain natriuretic peptide (BNP), an increase in left atrial volume, and an overall reduction in peak left ventricular global longitudinal strain. All subjects had a similar value of global work index, the average myocardial work, premarathon. Global work index did not change in 11 patients (Group 1), and global work index increased in 13 patients (Group 2) immediately postmarathon. Group 2 patients were noted to have higher heart rate, lower end-diastolic and end-systolic volumes, and higher BNP levels, suggesting myocardial stress. Conclusions South Asian athletes completing a half marathon exhibited two different responses to the cardiac stress of the half marathon, as outlined by the use of myocardial work indices, a novel method for assessing cardiac performance.
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Affiliation(s)
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's/Aurora Sinai Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | | | - Susan Olet
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's/Aurora Sinai Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI.,Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, WI
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Abstract
Purpose Previous studies have noted consequences of ultra-distance trail running on health, but few studies are available regarding the temporal variations of renal biomarker injury during the running. The aim of this study was to assess the of kidney function parameters temporal variation during and on short-term after an ultra-distance race. Methods We performed an observational study with 47 subjects participating in an ultra-distance race (80 km). Urine (47 subjects) and blood (21 subjects) samples were serially collected before (baseline—km 0), during (21 and 53 km), on arrival (80 km), and 9 days after the race (d9). Results Mean serum creatinine increased during the race from 90±14 μmol/L (km0) to 136±32 μmol/L (km 80—p<0.0001) corresponding to a 52% increase. Mean creatininuria progressively increased from 4.7±4.5 mmol/L (km 0) to 22.8±12.0 mmol/L (km 80) (p<0.0001). Both urinary biomarkers (Neutrophil Gelatinase Associated Lipocalin and Kidney Injury Molecule-1) of acute kidney injury (AKI) progressively increased during the race (p<0.05 vs baseline). However, after adjustment to urine dilution by urine creatinine, no significant changes remained (p>0.05). On day 9, no significant difference remains in blood and urine biomarkers compared to their respective baseline levels. Conclusions During an ultra-distance race, despite an acute and transient increase in the serum creatinine levels, urinary biomarkers of AKI displayed only limited changes with a complete regression on day 9. These results suggest the absence of the short-term impact of an ultra-distance race kidney function.
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13
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Sengupta SP, Mahure C, Mungulmare K, Grewal HK, Bansal M. Myocardial fatigue in recreational marathon runners: A speckle-tracking echocardiography study. Indian Heart J 2018; 70 Suppl 3:S229-S234. [PMID: 30595264 PMCID: PMC6309569 DOI: 10.1016/j.ihj.2018.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022] Open
Abstract
Background Prolonged aerobic exercise such as marathon running produces supraphysiological hemodynamic stress that can potentially affect the athlete's cardiac homeostasis. While cardiac structural and functional adaptations in professional athletes are well characterized, only a limited information is available for recreational runners undergoing this supraphysiological stress. Methods Premarathon and post-marathon echocardiography was performed in 50 recreational marathon runners [age 40.8 ± 7.5 years, 44 (88%) males; running distance 42.195 km]. All the runners received 4-month training for the marathon. The baseline echocardiogram and N-terminal B-type natriuretic peptide (NT-proBNP) were obtained before training, whereas the post-marathon study was performed within 10 days (7.27 ± 0.92 days) of completion of marathon. Two-dimensional speckle-tracking echocardiography was used for characterizing the changes in myocardial mechanics. Results There was a significant reduction in heart rate post-marathon, whereas the levels of NT-proBNP increased significantly (86.0 ± 9.5 pg/ml vs 106.5 ± 24.2 pg/ml, p = 0.001). The left ventricular (LV) end-diastolic volume (61.8 ± 16.5 ml vs 72.8 ± 5.1 ml, p < 0.001), LV mass (120.2 ± 30.0 gm vs 160.3 ± 43.0 gm, p < 0.001), and LV ejection fraction (64.9 ± 5.6% vs 72.0 ± 5.7%, p < 0.001) also increased significantly. However, there was a significant attenuation in LV global longitudinal (−19.3 ± 2.71% vs −16.5 ± 4.6%, p = 0.003) and circumferential strain (−17.2 ± 2.41% vs −15.2 ± 2.6%, p = 0.001) post-marathon. The LV global radial strain showed a nonsignificant reduction. Conclusion Recreational marathon runners have reduced longitudinal and circumferential shortening of the left ventricle with elevation of NT-proBNP. However, the LV ejection performance remains maintained because of an increase in the LV end-diastolic volume and mass. These changes suggest the possibility of “myocardial fatigue” occurring in response to supraphysiological hemodynamic stress of marathon running.
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Affiliation(s)
| | - Chetan Mahure
- Sengupta Hospital and Research Institute, Ravinagar, Nagpur, India
| | - Kunda Mungulmare
- Sengupta Hospital and Research Institute, Ravinagar, Nagpur, India
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14
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Taksaudom N, Tongsiri N, Potikul A, Leampriboon C, Tantraworasin A, Chaiyasri A. Race predictors and hemodynamic alteration after an ultra-trail marathon race. Open Access J Sports Med 2017; 8:181-187. [PMID: 29070954 PMCID: PMC5640401 DOI: 10.2147/oajsm.s142040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Unique rough-terrain ultra-trail running races have increased in popularity. Concerns regarding the suitability of the candidates make it difficult for organizers to manage safety regulations. The purpose of this study was to identify possible race predictors and assess hemodynamic change after long endurance races. METHODS We studied 228 runners who competed in a 66 km-trail running race. A questionnaire and noninvasive hemodynamic flow assessment including blood pressure, heart rate, stroke volume, stroke volume variation, systemic vascular resistance, cardiac index, and oxygen saturation were used to determine physiologic alterations and to identify finish predictors. One hundred and thirty volunteers completed the questionnaire, 126 participants had a prerace hemodynamic assessment, and 33 of these participants completed a postrace assessment after crossing the finish line. The participants were divided into a finisher group and a nonfinisher group. RESULTS The average age of all runners was 37 years (range of 24-56 years). Of the 228 runners, 163 (71.5%) were male. There were 189 (82.9%) finishers. Univariable analysis indicated that the finish predictors included male gender, longest distance ever run, faster running records, and lower diastolic pressure. Only a lower diastolic pressure was a significant predictor of race finishing (diastolic blood pressure 74-84 mmHg: adjusted odd ratio 3.81; 95% confidence interval [CI] =1.09-13.27 and diastolic blood pressure <74 mmHg: adjusted odd ratio 7.74; 95% CI =1.57-38.21) using the figure from the multivariable analysis. Among the finisher group, hemodynamic parameters showed statistically significant differences with lower systolic blood pressure (135.9±14.8 mmHg vs 119.7±11.3 mmHg; p<0.001), faster heart rate (72.6±10.7 bpm vs 96.4±10.4 bpm; p<0.001), lower stroke volume (43.2±13.6 mL vs 29.3±10.1 mL; p<0.001), higher stroke volume variation; median (interquartile range) (36% [25%-58%] vs 53% [33%-78%]; p<0.001), and lower oxygen saturation (97.4%±1.0% vs 96.4%±1.0%; p<0.001). Systemic vascular resistance and cardian index did not change significantly. CONCLUSION The only race finishing predictor from the multivariable analysis was lower diastolic pressure. Finishers seem to have a hypovolemic physiologic response and a lower level of oxygen saturation.
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Affiliation(s)
- Noppon Taksaudom
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Chiang Mai University Hospital
| | - Natee Tongsiri
- Department of Mathematics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Amarit Potikul
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Chiang Mai University Hospital
| | - Chawakorn Leampriboon
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Chiang Mai University Hospital
| | - Apichat Tantraworasin
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Chiang Mai University Hospital
| | - Anong Chaiyasri
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Chiang Mai University Hospital
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Romero SA, Minson CT, Halliwill JR. The cardiovascular system after exercise. J Appl Physiol (1985) 2017; 122:925-932. [PMID: 28153943 DOI: 10.1152/japplphysiol.00802.2016] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 11/22/2022] Open
Abstract
Recovery from exercise refers to the time period between the end of a bout of exercise and the subsequent return to a resting or recovered state. It also refers to specific physiological processes or states occurring after exercise that are distinct from the physiology of either the exercising or the resting states. In this context, recovery of the cardiovascular system after exercise occurs across a period of minutes to hours, during which many characteristics of the system, even how it is controlled, change over time. Some of these changes may be necessary for long-term adaptation to exercise training, yet some can lead to cardiovascular instability during recovery. Furthermore, some of these changes may provide insight into when the cardiovascular system has recovered from prior training and is physiologically ready for additional training stress. This review focuses on the most consistently observed hemodynamic adjustments and the underlying causes that drive cardiovascular recovery and will highlight how they differ following resistance and aerobic exercise. Primary emphasis will be placed on the hypotensive effect of aerobic and resistance exercise and associated mechanisms that have clinical relevance, but if left unchecked, can progress to symptomatic hypotension and syncope. Finally, we focus on the practical application of this information to strategies to maximize the benefits of cardiovascular recovery, or minimize the vulnerabilities of this state. We will explore appropriate field measures, and discuss to what extent these can guide an athlete's training.
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Affiliation(s)
- Steven A Romero
- University of Texas Southwestern Medical Center, Dallas, Texas.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas; and
| | | | - John R Halliwill
- Department of Human Physiology, University of Oregon, Eugene, Oregon
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Bittencourt CRDO, Izar MCDO, Schwerz VL, Póvoa RMDS, Fonseca HAR, Fonseca MIH, Bianco HT, França CN, Ferreira CEDS, Fonseca FAH. Effects of High-Intensity Training of Professional Runners on Myocardial Hypertrophy and Subclinical Atherosclerosis. PLoS One 2016; 11:e0166009. [PMID: 27835659 PMCID: PMC5106016 DOI: 10.1371/journal.pone.0166009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022] Open
Abstract
To evaluate the effects of long-term exposure to high-intensity training among professional runners on cardiac hypertrophy and subclinical atherosclerosis. Prospective study included runners of both sexes (n = 52) and age and gender matched controls (n = 57), without classical cardiovascular risk factors. Ventricular hypertrophy was quantified by echocardiography by linear method and carotid intima-media thickness (cIMT) by 2-D images obtained by ultrasonography. Endothelial function was evaluated by flow-mediated dilation (FMD). Steroid hormones were quantified by HPLC followed by LC-MS/MS. Higher left ventricular (LV) mass index was found in male athletes (p<0.0001 vs. other groups). When adjusted for gender, the degree of left ventricular mass index classified as mildly, moderately or severely abnormal was obtained in 26%, 35%, and 30%, respectively, of female athletes, and in 39%, 14%, and 21%, respectively, of male athletes. Higher ratio of the early (E) to late (A) ventricular filling velocities was found in athletes of both genders. Male athletes presented lower cIMT in the right (p = 0.012 vs. male controls) and left (p<0.0001 vs. male controls) common carotid arteries, without differences in cIMT between female athletes and controls. FMD results were similar among groups. Higher serum testosterone levels were found in male athletes (p<0.0001 vs. other groups) and they were correlated with LV mass (r = 0.50, p<0.0001). The chronic exposure of high-intensity training among professional runners of both genders was associated with increased ventricular mass and adaptive remodeling. Less subclinical atherosclerosis was found in male athletes. Differences in steroid hormones may account in part for these findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Carolina Nunes França
- Cardiology Division, Federal University of Sao Paulo, Sao Paulo, Brazil
- University of Santo Amaro, Sao Paulo, Brazil
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