The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

Abstract

Purpose: There is contradictory evidence related to the impact of ultra-marathon running on right ventricular (RV) structure and function. Consequently, the aims of this study were to; 1) comprehensively assess RV structure and function before and immediately following a 100 mile ultramarathon in highly trained runners, 2) determine the nature of RV recovery 6 hours post-race, and 3) document 12-lead electrocardiogram (ECG) changes post-exercise.Methods: Echocardiography and 12-lead ECG were assessed in 15 competitors in a repeated measures design before and immediately after completion of the 2013 Western States Endurance Race. A subset of 9 were reassessed 6 hours into recovery. Standard echocardiography was used to determine RV size, function and wall stress. Myocardial speckle tracking (MST) provided peak, time to peak and temporal indices for RV longitudinal strain and strain rates (ε and SR).Results: RV size was increased post-race (inflow tract 14 %, outflow tract 11 %, P = 0.004 and 0.002). RV wall stress was elevated by 11 % post-race. Peak RV ε was reduced by 10 % (P = 0.007) and significantly delayed post-race (P = 0.008). Most changes in RV function persisted at the 6 hour assessment. Post-race there was an increase in the prevalence of right-sided ECG changes. Conclusions:Completion of a 100 mile ultra-marathon resulted in acute changes in RV structure and function that persisted 6 hours into recovery and are consistent with sustained exposure to an elevated RV wall stress. These findings were supported by right sided changes to the 12-Lead ECG.

Exploratory insights from the right‐sided electrocardiogram following prolonged endurance exercise

“…Kucher and colleagues (2003) presented similar 12-lead ECG findings in patients following pulmonary embolism and suggest that this was consistent with RV strain (Kucher et al 2003) and these finding are also supported by data from Lord et al (2014) where similar repolarization changes are evident in the presence of a marked elevation in RV afterload. There was a significant increase in QTc interval, with 11 athletes meeting criteria for long QT syndrome following the race.…”

“…A recent study by our research group (Lord et al, 2014) assessed 12-lead electrocardiogram (ECG) changes following a 100 mile ultra-marathon and demonstrated an increase in the summated R wave in V1 and S wave in V5, J point elevation in V1, partial right bundle branch block (RBBB), T wave inversion in lead V1 and early repolarisation pre to post-race pointing to changes in the right-sided electrical conduction system. Nevertheless, the use of right-sided ECG leads, focusing on the right heart, have not been employed in this setting.…”

Medex 2015: The key role of cardiac mechanics to maintain biventricular function at high altitude

“…Third, several parameters measured in the present study could be significantly influenced not only by altitude, but also by the physical activity associated with trekking. However, previous studies reported that even after long‐distance running for several days, there was a decrease or no change in cardiac strain data in healthy participants (George et al., ; Lord et al., ; Nottin et al., ). Thus, exposure to high altitude seems to be the main trigger of the cardiac changes observed in the present study.…”

The acute impact of an ultramarathon on right heart: A 12‐lead ECG study

“…As a consequence, repetitive bouts of myocardial damage due to exercise without a complete recovery may translate into an adverse arrhythmic remodeling, exposing the athlete to the risk of sudden cardiac death . However, the consequences of ultra‐endurance sports activity on the heart rhythm and on ECG have not been entirely understood, although an electrical instability of the ventricular myocardium and right‐sided acute changes in ECG were found in athletes after endurance races . Furthermore, few studies have collected data with 12‐lead ECG in athletes running an ultramarathon.…”

“…4 However, the consequences of ultra-endurance sports activity on the heart rhythm and on ECG have not been entirely understood, although an electrical instability of the ventricular myocardium and right-sided acute changes in ECG were found in athletes after endurance races. [5][6][7] Furthermore, few studies have collected data with 12-lead ECG in athletes running an ultramarathon. Therefore, the aim of this study was to evaluate by 12-lead ECG the acute effects of an ultramarathon on heart rhythm and on ECG signs of right ventricular overload.…”