Blood cardiac biomarkers responses are associated with 24 h ultramarathon performance

Effects of Long-Term Endurance Exercise on Cardiac Morphology, Function, and Injury Indicators among Amateur Marathon Runners

The purpose of this study was to investigate the effects of long-term endurance exercise on cardiac morphology and function, as well as injury indicators, among amateur marathon runners. We recruited 33 amateur runners who participated in a marathon. Participants were divided into experimental and control groups according to their National Athletic Grade. The experimental group included participants with a National Athletic Grade of 2 or better, and the control group included participants who did not have a National Athletic Grade. Cardiac morphology, function, and injury indicators were assessed before and after the participants' involvement in the Changsha International Marathon. All cardiac morphology and function indicators returned to pre-race levels at 24 h post-race, and left ventricular end-diastolic volume and left ventricular end-systolic volume indicators showed similar trends. Both stroke volume (SV) and percent fractional shortening (%FS) indicators showed similar trends in changes in the measurements before and after the race. SV showed no change between the pre-race and post-race periods. On the other hand, %FS showed a significant increase in the immediate post-race period, followed by restoration of its level at 24 h post-race. Among myocardial injury indicators, serum levels of cardiac troponin I, creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and N-terminal pro-b-type natriuretic peptide (NT-proBNP) measured before the race, immediately after the race, and 24 h after the race displayed similar trends in changes among CK, CK-MB, LDH, and AST, while NT-proBNP levels did not change. We concluded that high-level amateur marathon runners had greater heart volumes, as well as wall and septal thicknesses, than low-level marathon runners, with differences in heart volume being the most pronounced. Long-term high-intensity endurance exercise caused some damage to the hearts of amateur runners. High-level runners showed better myocardial repair ability, and their levels of myocardial injury markers showed greater decreases at 24 h post-race, while low-level runners had poorer myocardial repair ability.

Running for Your Life: Metabolic Effects of a 160.9/230 km Non-Stop Ultramarathon Race on Body Composition, Inflammation, Heart Function, and Nutritional Parameters

Moderate endurance exercise leads to an improvement in cardiovascular performance, stress resilience, and blood function. However, the influence of chronic endurance exercise over several hours or days is still largely unclear. We examined the influence of a non-stop 160.9/230 km ultramarathon on body composition, stress/cardiac response, and nutrition parameters. Blood samples were drawn before (pre) and after the race (post) and analyzed for ghrelin, insulin, irisin, glucagon, cortisol, kynurenine, neopterin, and total antioxidant capacity. Additional measurements included heart function by echocardiography, nutrition questionnaires, and body impedance analyses. Of the 28 included ultra-runners (7f/21m), 16 participants dropped out during the race. The remaining 12 finishers (2f/10m) showed depletion of antioxidative capacities and increased inflammation/stress (neopterin/cortisol), while energy metabolism (insulin/glucagon/ghrelin) remained unchanged despite a high negative energy balance. Free fat mass, protein, and mineral content decreased and echocardiography revealed a lower stroke volume, left end diastolic volume, and ejection fraction post race. Optimizing nutrition (high-density protein-rich diet) during the race may attenuate the observed catabolic and inflammatory effects induced by ultramarathon running. As a rapidly growing discipline, new strategies for health prevention and extensive monitoring are needed to optimize the athletes’ performance.

The relationship between cardiac damage biomarkers and heart rate variability following 60 min of running

PURPOSE

Endurance exercise may cause transient alterations in cardiac tissue. The number of studies evaluating the relationship between changes in heart rate variability (HRV) and cardiac biomarkers following an endurance event is limited. We hypothesized that there would be a time-dependent correlation between biomarkers of cardiac damage and the reduction in parasympathetic indices of HRV within 24 h after 60 min of running in middle-aged recreational runners.

METHODS

The trained, middle-aged runners who participated in this study ran 60 min at a half-marathon pace on a treadmill. Blood samples (before and 0, 4, and 24 h after the running test) and HRV data (before and 0, 1, 4, and 24 h after the running test) were obtained.

RESULTS

After running, cardiac biomarkers (total creatine kinase, cardiac isoform of creatine kinase, creatine kinase-index [CK-Index], cardiac troponin [cTnI]) increased significantly, and HRV measures related to parasympathetic nervous system activity decreased significantly; these measures returned to baseline levels within 24 h. Finally, there were significant correlations (all p < 0.05) between the change (4 h post-running vs. pre-running) in the CK-Index and the changes (post- vs pre-running) in time-domain and nonlinear measures of HRV (r - 0.61 to - 0.67). In addition, significant correlations (all p < 0.05) were found between the area under the cTnI curve and change (1-h post- and pre-running) in time-domain and nonlinear measures of HRV (r - 0.48 to - 0.51).

CONCLUSIONS

The correlation between HRV and cardiac biomarkers indicates that HRV analysis may be an alternative approach to determine the magnitude of cardiac stress after endurance exercises.

Circulating microRNAs after a 24-h ultramarathon run in relation to muscle damage markers in elite athletes

Ultra-endurance sports are growing in popularity but can be associated with adverse health effects, such as exercise-induced muscle damage (EIMD), which can lead to exertional rhabdomyolysis. Circulating microRNAs (miRNAs) may be useful to approach the degree of EIMD. We aimed to (1) investigate the relevance of circulating miRNAs as biomarkers of muscle damage and (2) examine the acute response of skeletal/cardiac muscle and kidney biomarkers to a 24-h run in elite athletes. Eleven elite athletes participated in the 24-h run World Championships. Counter-movement jump (CMJ), creatine kinase (CK), myoglobin (Mb), creatinine (Cr), high-sensitive cardiac troponin T (hs-cTnT), and muscle-specific miRNA (myomiR) levels were measured before, immediately after, and 24 and 48h after the race. CMJ height was reduced immediately after the race (-84.0 ± 25.2%, p < 0.001) and remained low at 24 h (-43.6 ± 20.4%, p = 0.002). We observed high CK activity (53 239 ± 63 608 U/L, p < 0.001) immediately after the race, and it remained elevated 24h after (p < 0.01). Circulating myomiR levels (miR-1-3p, miR-133a-3p, miR-133b, miR-208a-3p, miR-208b-3p, and miR-499a-5p) were elevated immediately after the 24-h run (fold changes: 18-124,723, p<0.001) and significantly (p < 0.05) correlated or tended to significantly (p < 0.07) correlate with the reduction in CMJ height at 24 h. We found no significant correlation between CMJ height loss at 24 h and CK (p = 0.23) or Mb (p = 0.41) values. All elite ultramarathon runners included in our study were diagnosed with exertional rhabdomyolysis after the 24-h ultramarathon race. MyomiR levels may be useful to approach the degree of muscle damage.

Effects of Ultratrail Running on Neuromuscular Function, Muscle Damage and Hydration Status. Differences According to Training Level

The status of trail running races has exponentially grown in recent years. The present study aimed to: (a) evaluate the acute response of ultratrail racing in terms of neuromuscular function, muscle damage and hydration status; (b) analyze if responses could differ according to training levels. Twenty runners participated in the present study. The participants were divided into amateur training level (n = 10; 43.30 ± 4.52 years) or high level competitors (n = 10; 41.40 ± 6.18). Neuromuscular response (squat jump, countermovement jump and Abalakov jump), muscle damage (alanine aminotransferase, bilirubin, creatine kinase and leukocytes) and hydration status (sodium and creatinine) were evaluated before and after the Guara Somontano Ultratrail Race (108 km distance, with an accumulated slope of 5800 m). The height and power achieved by vertical jumps were lower after the race (p < 0.001). The post-race muscle damage and creatinine parameters increased in both groups (p < 0.001). The high-level group obtained lower percentages of change in squat jump and countermovement jump than the amateur-level group (p < 0.05). However, the increase in creatinine was greater for the high-level group (p < 0.05). Ultratrail racing reduces neuromuscular function and increases muscle damage. High-level runners showed less neuromuscular fatigue compared to amateur ones.

Cardiac Biomarkers Following Marathon Running: Is Running Time a Factor for Biomarker Change?

PURPOSE

Plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T levels show a transient increase after marathon running. The aim of this study was to investigate whether running duration influences the patterns of changes in cardiac biomarkers.

METHODS

Twenty participants with fast and slow finishing times were included in the study. Blood samples were taken before the marathon race, immediately after, and 24 hours after the race. Samples were analyzed for NT-proBNP and cardiac troponin T concentration. Furthermore, a complete blood cell count was performed.

RESULTS

After the marathon race, the fast and slow runners showed similar changes of NT-proBNP and cardiac troponin T (ie, a transient increase). Curve estimation regression analysis showed a curvilinear relationship (quadratic model) between running times and NT-proBNP increments immediately after the race, with less of an increase in the very fast and the very slow runners (r2 = .359, P = .023). NT-proBNP increments immediately after the race were correlated to the decline 24 hours after the marathon (r = -.612, P = .004).

CONCLUSIONS

This study indicates that NT-proBNP release immediately after marathon running varies in a curvilinear fashion with running time. It is speculated that low NT-proBNP release is associated with training adaptation in most elite runners and the relatively low cardiac stress in the slowest (but experienced) runners. The combination of less adaptation and relatively large cardiac wall and metabolic stress may explain the highest NT-proBNP values in runners with average running times. In addition, NT-proBNP decrements 24 hours after the race depend primarily on the values reached after the marathon and not on running time.

Serum changes in sTWEAK and its scavenger receptor sCD163 in ultramarathon athletes running the 24-h race

In the present investigation, the serum changes of sTWEAK levels, a multifunctional cytokine involved in tissue response to acute injury and inflammation, and of its scavenger receptor sCD163, were monitored for the first time in ultramarathon athletes running the 24-h competition, an extremely demanding race in terms of muscular and physiological exertion. To this aim, venous blood samples were collected from each participant (n = 22, M = 12, F = 10) both before and immediately after the 24-h running. Other than sTWEAK and sCD163, the common serum biomarkers of inflammation (namely CRP and IL-6) and tissue injury (such as CPK, LDH, CPK-MB, troponin-I, and NT-proBNP) were evaluated. All parameters were within the reference ranges at baseline, indicating no alterations of the normal physiological processes before the competition; on the contrary, most biomarkers of tissue damage and inflammation strongly increased after the ultramarathon race. Interestingly, a significant decrement of sTWEAK levels associated with an increment of its scavenger receptor sCD163 was observed at post-race. Positive relationships were evidenced between IL-6 and sCD163 levels and the markers of cardiac damage troponin-I and NT-proBNP. On the contrary, sTWEAK showed an inverse correlation with IL-6 and NT-proBNP. This study opens the way to further investigations aimed at clarifying the role of TWEAK pathway during the prolonged ultraendurance activity, paying particular attention to the link of IL-6, CD163 and TWEAK with the cardiac function.

Right Knee-The Weakest Point of the Best Ultramarathon Runners of the World? A Case Study

The impact of ultramarathons (UM) on the organs, especially in professional athletes, is poorly understood. We tested a 36-year-old UM male runner before and after winning a 24-h marathon. The primary goal of the study was cardiovascular assessment. The athlete experienced right knee pain for the first time after 12 h of running (approximately 130 km), which intensified, affecting his performance. The competitors ran on a 1984 m rectangle-loop (950 × 42 m) in an atypical clockwise fashion. The winner completed 516 rectangular corners. Right knee Magnetic Resonance Imaging (MRI) one day after the run showed general overload in addition to degenerative as well as specific features associated with “turning to the right”. Re-examination after three years revealed none of these findings. Different kinds of overloading of the right lower limb, including right knee pain, were indicated in 6 of 10 competitors from the top 20, including a woman who set the world record. The affected competitors suggested as cause for discomfort the shape of the loop and running direction. They believed that changing the direction of the run during the competition and an athletics stadium loop shape on a 2000–2500 m length is better for 24-h UM runners. In the absence of technical alternatives, the “necessary evil” is a counterclockwise run (also Association of Athletics Federations IAAF recommendation). Results suggest that a one-way, clockwise, 24-h UM run had an adverse effect on the athlete’s right knee, as a result of unsymmetrical load. Organizers of 24-h UM runs should consider the shape of the competition loop and apply the principle of uniform load on the musculoskeletal system (alternate directions run). In case of technical impossibility, it would be better to run counterclockwise, which is more common, preferred by runners, and recommended by the IAAF.