Original article
Effect of Preload Augmentation on Pulsed Wave and Tissue Doppler Echocardiographic Indices of Diastolic Function After a Marathon

https://doi.org/10.1016/j.echo.2007.04.032Get rights and content

Background

The mechanisms underlying alterations in left ventricular diastolic function after a marathon are unknown and may be a consequence of a reduced preload.

Objective

We sought to assess the effect of preload augmentation through passive leg elevation (PLE) on echocardiographic indices of diastolic function after a marathon.

Methods

Fourteen trained participants (13 male) were echocardiographically assessed before and after a marathon in the supine position and during PLE. Diastolic function was measured via conventional Doppler, color M-mode, and tissue Doppler echocardiography. Early and late transmitral filling velocities (E and A, respectively), flow propagation velocity of early filling, and basal early and late left ventricular wall velocities (E’ and A’, respectively) were obtained.

Results

The E/A ratio, flow propagation velocity of early filling, and the E’/A’ ratio decreased by 31%, 24%, and 32%, respectively (P < .05), after marathon running. Postrace PLE returned E to baseline and increased E/A compared with postrace supine (P < .05). However, E/A remained depressed compared with baseline as a result of the persistent elevation in A. Postrace PLE caused Vp to return to baseline; mean E’ also increased (9%, P < .05), but did not return to resting levels. Mean A’ was unaffected by postrace PLE, therefore, E’/A’ was unchanged postrace despite PLE.

Conclusion

Postexercise alterations in Doppler indices of diastolic function can be partially explained by a reduction in preload. However, data from tissue Doppler echocardiography indicate that there is an intrinsic impairment in myocardial relaxation after marathon running.

Section snippets

Participants

After approval from our ethics committee, 14 trained athletes (13 male; mean ± SD; age 34 ± 7 years, height 1.77 ± 0.07 m, body mass 78.0 ± 8.2 kg) competing in the 2005 London Marathon provided written informed consent to participate in the study. Exclusion criteria included any personal or early family history of cardiopulmonary diseases.

Design

Participants were assessed 24 hours before the marathon and within 30 minutes of race completion. Identical procedures were completed on both occasions. Body

Results

Marathon completion time was 216 ± 40 minutes and all participants returned for postrace assessment within 30 minutes of race completion. Body mass was significantly reduced (78 ± 8 vs 75 ± 8 kg, P < .05).

Discussion

The current data provide unique evidence of altered LV diastolic function after a marathon, which can be partially reversed by returning preload toward pre-exercise levels. This effect is, however, partly dependent on the specific diastolic functional variable assessed.

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