Persistent and reversible cardiac dysfunction among amateur marathon runners

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Abstract
Aims Transient systolic and diastolic abnormalities in ventricular function have previously been documented during endurance sports. However, these described alterations may be limited by the techniques applied. We sought, using less load-dependent methods, to characterize both the extent and the chronology of the cardiac changes associated with endurance events. Methods and results Transthoracic echocardiography (TTE) was performed prior to, immediately after, and approximately 1 month after completion of the 2003 Boston Marathon in 20 amateur athletes. TTE included two-dimensional, spectral and tissue Doppler (TD) and flow propagation velocity (Vp). After completion of the marathon, global measures of left ventricular (LV) systolic function were unchanged (EF 59±6 vs. 61±4% post, P=0.14), whereas TD-derived measures of LV systolic function [septal strain −23±5 vs. −17±4%, P=0.007; septal strain rate (SR) −1.5±0.3 vs. −1.1±0.2 s−1, P=0.007] and right ventricular (RV) systolic function (RV apical strain −33±4 vs. −27±5%, P=0.001; RV apical SR −2.4±0.7 vs. −1.8±0.5, P=0.002) were reduced. Significant changes in transmitral velocity (E/A ratio 2.0±0.5 vs.1.3±0.3, P=0.005) and TD indices of LV and RV diastolic function (Ea septal 9.5±1.8 vs. 8.1±1.2 cm/s post-marathon, P=0.01) were also observed, indicating an inherent alteration in LV relaxation. Although all indices of LV and RV systolic function had returned to normal on follow-up, there were persistent diastolic abnormalities (RV Ea, 11.5±1.5 cm/s pre-marathon vs. 10.0±1.6 cm/s follow-up, P=0.01). Conclusion Marathon running leads to transient systolic and more persistent diastolic dysfunction of both the LV and the RV.