Impaired Left Ventricular Diastolic Function in Athletes After Utterly Strenuous Prolonged Exercise

Abstract

Digitized M mode echocardiography was used to evaluate the effect of a competitive 24-h run on the left ventricular diastolic function in 12 well-trained marathon runners who completed 146-227 km during the race. Mitral valve opening was delayed, early diastolic filling was decreased and prolonged, and posterior wall thinning was reduced, particularly among those athletes completing close to 200 km or more. Since the alterations were in part the opposite in those running 160 km or less, only the reductions in the peak rate of dimension increase (P less than 0.05) and posterior wall thinning (P less than 0.01) were significant in the group as a whole. The delay in mitral valve opening (r = 0.76), the decrease in the peak rate of dimension increase (r = -0.68), and the prolongation of the early diastolic filling period (r = 0.60) were correlated with the distance completed. The reductions in left ventricular end-diastolic dimension and fractional shortening were not in proportion to the distance run, however (r = 0.23 and 0.46, respectively). Measurements made on six athletes 2-3 days after the race showed reversal of the indices of left ventricular diastolic function. Extremely exhaustive prolonged exercise thus appears to result in a marked reversible impairment in left ventricular relaxation and filling. Since the effect of these abnormalities in cardiac filling during exercise is probably more important due to the shorter diastole, the prevention of hypohydration, which could otherwise further compromise left ventricular filling, becomes crucial.

Transient cardiac left ventricular diastolic dysfunction following strenuous exercise

“…In contrast with previous reports [1][2][3][20][21][22][23], our study did not show any significant change in systolic function after both competitions as well as in between the two races. Additionally, cardiac enzymes were within normal values after both races, confirming that no myocardial damage occurred in any athlete, as outlined by a previous study [24].…”

“…Previous studies have shown that trained athletes may develop different degrees of systolic and diastolic dysfunction following strenuous exercise [1][2][3][20][21][22][23]. These studies, which employed two-dimensional Doppler echocardiography, have shown transient left ventricular systolic and diastolic dysfunctions soon after prolonged exercise.…”

“…Prolonged competitive exercise in trained athletes has been shown to impair systolic and diastolic left ventricular function [1][2][3]. The rapid reversal of these alterations during recovery has suggested the term "cardiac fatigue" [2], but the long-term significance of such alterations has not been addressed.…”

Efeitos agudos do exercício físico prolongado: avaliação após ultramaratona de 24 horas

“…Regarding the diastolic function, the echocardiographic finding of a significant decrease in E/A ratio, commonly interpreted as the onset of diastolic dysfunction has been previously described 40 .…”

Altered left ventricular diastolic filling following a marathon is a reproducible phenomenon

“…Temporary release of cardiac biomarkers indicative of myocardial damage has also been observed following marathon running [3,4]. The reproducibility of these phenomena has not yet been investigated, despite evidence of inter-individual variability in altered left ventricular function parameters [5,6], and wide variation in exercise-induced cardiac troponin T (cTnT) release [3,4,7]. The aim of the present study was to examine the reproducibility of altered left ventricular function and cTnT release in the same cohort of athletes, following the completion of two identical marathons performed one year apart.…”