The Role of Three-Dimensional Echocardiography in the Assessment of Right Ventricular Dysfunction after a Half Marathon: Comparison with Cardiac Magnetic Resonance Imaging

doi:10.1016/j.echo.2010.10.012

Journal of the American Society of Echocardiography

Volume 24, Issue 2, February 2011, Pages 207-213

https://doi.org/10.1016/j.echo.2010.10.012 Get rights and content

Background

Although marathon running is associated with transient right ventricular (RV) systolic dysfunction as detected by two-dimensional transthoracic echocardiography, quantitative assessment of the right ventricle is difficult because of its complex geometry. Little is known about the use of real-time three-dimensional echocardiography (RT3DE) in the detection of cardiac dysfunction after a half marathon. The aim of this study was to assess the extent of RV dysfunction after the completion of a half marathon using cardiac biomarkers, RT3DE, and cardiac magnetic resonance imaging (CMR).

Methods

A prospective study was performed in 15 individuals in 2009 participating in the Manitoba Half Marathon. Cardiac biomarkers (myoglobin, creatine kinase–MB and cardiac troponin T) were assessed and RT3DE and CMR were performed 1 week before, immediately after, and 1 week after the race.

Results

At baseline, cardiac biomarkers and ventricular function were within normal limits. Immediately following the half marathon, all patients demonstrated elevated cardiac troponin T levels, with a median value of 0.37 ng/mL. RV ejection fraction, as assessed by RT3DE, decreased from 59 ± 4% at baseline to 45 ± 5% immediately following the race (P < .05). On CMR, RV end-diastolic volume increased after the half marathon, and the RV ejection fraction was reduced, at 47 ± 5% compared with 60 ± 2% at baseline (P < .05). There were strong linear correlations between RV ejection fraction assessed by RT3DE and CMR at baseline and after the half marathon (r = 0.69 and r = 0.87, P < .01, respectively).

Conclusions

Compared with CMR, RT3DE is a feasible and reproducible method of assessing transient RV dysfunction in athletes completing a half marathon.

Section snippets

Study Population

A prospective study involving 15 healthy, nonelite volunteers participating in the 2009 Manitoba Half Marathon was performed. Subjects aged 18 to 40 years who completed the race were included. Patients with histories of coronary artery disease, hypertension, smoking, elevated lipids, diabetes, and/or contraindication to undergo CMR were excluded.

Cardiac Biomarkers

Myoglobin, CK, and cTnT were evaluated at three separate time points: (1) 1 week before the race, (2) immediately after the race, (3) and 1 week after

Results

Of the 3,953 amateur athletes (1,971 men; mean age, 35 ± 13 years) who completed the 2009 Manitoba Half Marathon, the mean finishing time was 137 ± 26 min. Our study population of 15 participants (seven men; mean age, 32 ± 6 years) completed the half marathon with an average finishing time of 130 ± 24 min. The start time of the Manitoba Half Marathon was 7 am, and each study participant underwent TTE imaging 10 min after crossing the finish line. The first CMR was scheduled at 9 am, and

Discussion

The present study confirmed a significant increase in the release of cardiac biomarkers of injury after the completion of a half marathon. Our study is the first to demonstrate RV systolic dysfunction in the half marathon setting using real-time three-dimensional TTE imaging. Finally, this study demonstrated an absence of delayed enhancement on CMR, indicating that the increase in cTnT following a half marathon does not correspond to true myocardial necrosis.

Cardiac biomarkers, including

Conclusions

Compared with CMR, RT3DE is a feasible and reproducible method of assessing transient RV dysfunction in athletes completing a half marathon.

Acknowledgments

We would like to acknowledge and express our gratitude for the gracious support provided by the management staff and volunteers of the 2009 Manitoba Half Marathon.

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: This work was supported by funding from the St. Boniface General Hospital and Research Foundation. Dr. Jassal is the recipient of the Heart and Stroke Foundation New Investigator Award.

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Clinical InvestigationVentricular FunctionThe Role of Three-Dimensional Echocardiography in the Assessment of Right Ventricular Dysfunction after a Half Marathon: Comparison with Cardiac Magnetic Resonance Imaging

Background

Methods

Results

Conclusions

Section snippets

Study Population

Cardiac Biomarkers

Results

Discussion

Conclusions

Acknowledgments

Am J Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

Am Heart J

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Am J Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

Am J Cardiol

J Am Coll Cardiol

Magn Reson Imaging

Acad Radiol

Am Heart J

Cardiac injury markers in non-elite marathon runners

Int J Sports Med

Cardiac biomarkers, electrolytes, and other analytes in collapsed marathon runners: implications for the evaluation of runners following competition

Am J Clin Pathol

Cardiac markers (BNP, NT-pro-BNP, troponin I, troponin T, in female amateur runners before and up until three days after a marathon

Clin Lab

Elevation of cardiac troponin T after running is not limited to marathon runners

Cardiology

Cardiac fatigue after prolonged exercise

Circulation

Elevated serum cardiac markers in asymptomatic marathon runners after competition: is the myocardium stunned?

Cardiology

Clinical Investigation
Ventricular Function
The Role of Three-Dimensional Echocardiography in the Assessment of Right Ventricular Dysfunction after a Half Marathon: Comparison with Cardiac Magnetic Resonance Imaging