Published online before print November 13, 2006, doi: 10.1161/CIRCULATIONAHA.106.647461
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;114:2325-2333.)
© 2006 American Heart Association, Inc.
Exercise Physiology |
Myocardial Injury and Ventricular Dysfunction Related to Training Levels Among Nonelite Participants in the Boston Marathon
From the Cardiac Ultrasound Laboratory (T.G.N., J.L.J., T.-T.T.-N., D.M.Y., D.S.J., J.E.M., M.H.P., M.J.W.), Division of Cardiology, Pathology (E.L.-L., K.B.L.), and Pediatric Surgery (D.L.), Massachusetts General Hospital, and the Department of Medicine (A.J.S.), McLean Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiovascular Medicine (P.S.D.), Duke University Medical Center, Durham, NC.
Correspondence to Dr Malissa J. Wood, Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, 55 Fruit St, VBK 508, Boston, MA 02115-2696. E-mail mjwood{at}partners.org
Received June 21, 2006; revision received August 23, 2006; accepted August 25, 2006.
Background— Multiple studies have individually documented cardiac dysfunction and biochemical evidence of cardiac injury after endurance sports; however, convincing associations between the two are lacking. We aimed to determine the associations between the observed transient cardiac dysfunction and biochemical evidence of cardiac injury in amateur participants in endurance sports and to elicit the risk factors for the observed injury and dysfunction.
Methods and Results— We screened 60 nonelite participants, before and after the 2004 and 2005 Boston Marathons, with echocardiography and serum biomarkers. Echocardiography included conventional measures as well as tissue Doppler–derived strain and strain rate imaging. Biomarkers included cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP). All subjects completed the race. Echocardiographic abnormalities after the race included altered diastolic filling, increased pulmonary pressures and right ventricular dimensions, and decreased right ventricular systolic function. At baseline, all had unmeasurable troponin. After the race, >60% of participants had increased cTnT >99th percentile of normal (>0.01 ng/mL), whereas 40% had a cTnT level at or above the decision limit for acute myocardial necrosis (
0.03 ng/mL). After the race, NT-proBNP concentrations increased from 63 (interquartile range [IQR] 21 to 81) pg/mL to 131 (IQR 82 to 193) pg/mL (P<0.001). The increase in biomarkers correlated with post-race diastolic dysfunction, increased pulmonary pressures, and right ventricular dysfunction (right ventricular mid strain, r=–0.70, P<0.001) and inversely with training mileage (r=–0.71, P<0.001). Compared with athletes training >45 miles/wk, athletes who trained 
35 miles/wk demonstrated increased pulmonary pressures, right ventricular dysfunction (mid strain 16±5% versus 25±4%, P<0.001), myocyte injury (cTnT 0.09 versus <0.01 ng/mL, P<0.001), and stress (NT-proBNP 182 versus 106 pg/mL, P<0.001).
Conclusions— Completion of a marathon is associated with correlative biochemical and echocardiographic evidence of cardiac dysfunction and injury, and this risk is increased in those participants with less training.
CLINICAL PERSPECTIVE
This article has been cited by other articles:
 |
|
 |
|
  S. Nottin, G. Doucende, I. Schuster, S. Tanguy, M. Dauzat, and P. Obert Alteration in Left Ventricular Strains and Torsional Mechanics After Ultralong Duration Exercise in Athletes Circ Cardiovasc Imaging, July 1, 2009; 2(4): 323 - 330. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Teske, N. H. Prakken, B. W. De Boeck, B. K. Velthuis, E. P. Martens, P. A. Doevendans, and M. J. Cramer Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes Eur. Heart J., April 2, 2009; 30(8): 969 - 977. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. La Gerche, A. J. Taylor, and D. L. Prior Athlete's Heart: The Potential for Multimodality Imaging to Address the Critical Remaining Questions. J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 350 - 363. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Giannitsis, H. J. Roth, R. M. Leithauser, J. Scherhag, R. Beneke, and H. A. Katus New Highly Sensitivity Assay Used to Measure Cardiac Troponin T Concentration Changes During a Continuous 216-km Marathon Clin. Chem., March 1, 2009; 55(3): 590 - 592. [Full Text] [PDF]
|
|
|
|
 |
|
 K. George, R. Shave, D. Oxborough, T. Cable, E. Dawson, N. Artis, D. Gaze, T. Hew-Butler, K. Sharwood, and T. Noakes Left ventricular wall segment motion after ultra-endurance exercise in humans assessed by myocardial speckle tracking Eur J Echocardiogr, March 1, 2009; 10(2): 238 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Goodman, G.-M. Busato, E. Frey, and Z. Sasson Left ventricular contractile function is preserved during prolonged exercise in middle-aged men J Appl Physiol, February 1, 2009; 106(2): 494 - 499. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Mingels, L. Jacobs, E. Michielsen, J. Swaanenburg, W. Wodzig, and M. van Dieijen-Visser Reference Population and Marathon Runner Sera Assessed by Highly Sensitive Cardiac Troponin T and Commercial Cardiac Troponin T and I Assays Clin. Chem., January 1, 2009; 55(1): 101 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Dawson, G. P. Whyte, M. A. Black, H. Jones, N. Hopkins, D. Oxborough, D. Gaze, R. E. Shave, M. Wilson, K. P. George, et al. Changes in vascular and cardiac function after prolonged strenuous exercise in humans J Appl Physiol, November 1, 2008; 105(5): 1562 - 1568. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G Gratze, H Mayer, F C Luft, and F Skrabal Determinants of fast marathon performance: low basal sympathetic drive, enhanced postcompetition vasodilatation and preserved cardiac performance after competition Br. J. Sports Med., November 1, 2008; 42(11): 882 - 888. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. L. Baggish, K. Yared, F. Wang, R. B. Weiner, A. M. Hutter Jr., M. H. Picard, and M. J. Wood The impact of endurance exercise training on left ventricular systolic mechanics Am J Physiol Heart Circ Physiol, September 1, 2008; 295(3): H1109 - H1116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mohlenkamp, N. Lehmann, F. Breuckmann, M. Brocker-Preuss, K. Nassenstein, M. Halle, T. Budde, K. Mann, J. Barkhausen, G. Heusch, et al. Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners Eur. Heart J., August 1, 2008; 29(15): 1903 - 1910. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund, T. Voigtlander, and B. Nowak The risk of marathon runners-live it up, run fast, die young? Eur. Heart J., August 1, 2008; 29(15): 1800 - 1802. [Full Text] [PDF]
|
|
|
|
|
|
E E Turk, A Riedel, and K Pueschel Natural and traumatic sports-related fatalities: a 10-year retrospective study Br. J. Sports Med., July 1, 2008; 42(7): 604 - 608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Baggish, F. Wang, R. B. Weiner, J. M. Elinoff, F. Tournoux, A. Boland, M. H. Picard, A. M. Hutter Jr., and M. J. Wood Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes J Appl Physiol, April 1, 2008; 104(4): 1121 - 1128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. D. Huebner, D. S. Jassal, O. Halevy, M. Pines, and J. E. Anderson Functional resolution of fibrosis in mdx mouse dystrophic heart and skeletal muscle by halofuginone Am J Physiol Heart Circ Physiol, April 1, 2008; 294(4): H1550 - H1561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Ector and H. Heidbuchel Arrhythmias and the athlete: mechanisms and clinical significance: reply Eur. Heart J., June 1, 2007; 28(11): 1401 - 1401. [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Thompson, F. S. Apple, and A. Wu Marathoner's Heart? Circulation, November 28, 2006; 114(22): 2306 - 2308. [Full Text] [PDF]
|
|