Early subclinical increase in pulmonary water content in athletes performing sustained heavy exercise at sea level: ultrasound lung comet-tail evidence

Abstract

Gemignani A, L=Abbate A. Early subclinical increase in pulmonary water content in athletes performing sustained heavy exercise at sea level: ultrasound lung comet-tail evidence. Am J Physiol Heart Circ Physiol 301: H2161-H2167, 2011. First published August 26, 2011; doi:10.1152/ajpheart.00388.2011.-Whether prolonged strenuous exercise performed by athletes at sea level can produce interstitial pulmonary edema is under debate. Chest sonography allows to estimate extravascular lung water, creating ultrasound lung comet-tail (ULC) artifacts. The aim of the study was to determine whether pulmonary water content increases in Ironmen (n ϭ 31) during race at sea level and its correlation with cardiopulmonary function and systemic proinflammatory and cardiac biohumoral markers. A multiple factor analysis approach was used to determine the relations between systemic modifications and ULCs by assessing correlations among variables and groups of variables showing significant pre-post changes. All athletes were asymptomatic for cough and dyspnea at rest and after the race. Immediately after the race, a score of more than five comet tail artifacts, the threshold for a significant detection, was present in 23 athletes (74%; 16.3 Ϯ 11.2; P Ͻ 0.01 ULC after the race vs. rest) but decreased 12 h after the end of the race (13 athletes; 42%; 6.3 Ϯ 8.0; P Ͻ 0.01 vs. soon after the race). Multiple factor analysis showed significant correlations between ULCs and cardiac-related variables and NH2-terminal pro-brain natriuretic peptide. Healthy athletes developed subclinical increase in pulmonary water content immediately after an Ironman race at sea level, as shown by the increased number of ULCs related to cardiac changes occurring during exercise. Hemodynamic changes are one of several potential factors contributing to the mechanisms of ULCs. pulmonary edema EVEN IN HEALTHY SUBJECTS EXTREMELY demanding endurance exercise leads to functional and structural cardiac and pulmonary changes, along with local and systemic responses, reflecting oxidative, metabolic, hormonal, and thermal stress, besides immunomodulation and inflammatory reaction (4,30,32,40,41,46). Whether interstitial pulmonary edema occurs in athletes performing heavy sea level exercise is debated (2,6,12,18,19,27,28,44,56). Interstitial pulmonary edema has been documented in endurance athletes performing heavy sea level exercise, using imaging techniques such as chest X-ray, magnetic resonance, computed tomography, and scintigraphy (17,36,56). Previous authors measured noninvasively the postexercise extracellular thoracic fluid volume using thoracic impedance monitoring (16). However, this method does not allow visualizing the seat of the water content in the chest. Chest sonography can be used in the field for assessment of athletes immediately after the end of exercise (11,34,35). This technique effectively detects and quantifies extravascular lung water, creating ultrasound lung comet-tail (ULC) artifacts from water-thickened pulmonary interlobular septa (11). In a pi...

Hypothesised mechanisms of swimming-related death: a systematic review

“…This extravascular fluid resolved by 12 h postevent (p<0.01) 21. These findings appear to support that extravascular fluid may appear after a long-distance triathlon, although in asymptomatic athletes the clinical relevance is uncertain.…”

“…Finally, using a novel ultrasound technique to evaluate for extravascular lung water, Pingitore et al evaluated 31 ironman triathlon (2.4 mile swim, 112 mile bike, 26.2 mile run) competitors (29 males and 2 females), and found that immediately after the event, despite remaining asymptomatic, 23 of 31 athletes (74%) demonstrated evidence of increased extravascular fluid compared to only 2 athletes (6.4%) before the event (p<0.01) 21. This extravascular fluid resolved by 12 h postevent (p<0.01) 21.…”

“…These symptoms were more likely to occur in longer events and to females 20. Additionally, participants who completed iron-distance triathlon were more likely to have extravascular lung fluid when evaluated by ultrasound;21 however, it is unclear whether this leads to symptoms of SIPE or is only an ultrasonographic finding. Finally, in those who have had a previous severe SIPE event, the recurrence rate is much higher 19.…”

Pulmonary Aspects of Exercise and Sports

“…They used ultrasound to detect lung edema and reported the incidence of ultrasound lung comets. 13 None of the athletes had evidence of lung edema before the event, while 75% showed evidence of pulmonary edema immediately post-race, and 42% had persistent findings of pulmonary edema 12 hours post-race. Their data and several case reports [14][15][16] have demonstrated that extreme exercise can result in pulmonary edema and support the findings of West et al …”

Lung injury related to extreme environments

“…Evidence for pulmonary oedema has been shown in competitive rowers [28], during exertion in dry cold environments and in cases of emotional stress and sexual intercourse [29], in addition to long distance runners and triathletes [30][31][32][33][34][35][36][37][38][39][40] and competitive cyclists [41,42]. The importance of mild oedema in reducing exercise capacity has been questioned [43].…”