Acute impact of an endurance race on biventricular and biatrial myocardial strain in competitive male and female triathletes evaluated by feature-tracking CMR

Hang Chen,Antonia Beitzen-Heineke,Gunnar K Lund,Charlotte M Jahnke,Anna Kisters,Ersin Cavus,Gerhard Adam,Enver Tahir,Monika Swiderska,Kai Muellerleile,Dennis Saering,Malte L Warncke

doi:10.1007/s00330-021-08401-y

Abstract

ObjectivesCardiac adaptation in endurance athletes is a well-known phenomenon, but the acute impact of strenuous exercise is rarely reported on. The aim of this study was to analyze the alterations in biventricular and biatrial function in triathletes after an endurance race using novel feature-tracking cardiac magnetic resonance (FT-CMR).MethodsFifty consecutive triathletes (45 ± 10 years; 80% men) and twenty-eight controls were prospectively recruited, and underwent 1.5-T CMR. Biventricular and biatrial volumes, left ventricular ejection fraction (LVEF), FT-CMR analysis, and late gadolinium imaging (LGE) were performed. Global systolic longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were assessed. CMR was performed at baseline and following an endurance race. High-sensitive troponin T and NT-proBNP were determined. The time interval between race completion and CMR was 2.3 ± 1.1 h (range 1–5 h).ResultsPost-race troponin T (p < 0.0001) and NT-proBNP (p < 0.0001) were elevated. LVEF remained constant (62 ± 6 vs. 63 ± 7%, p = 0.607). Post-race LV GLS decreased by tendency (− 18 ± 2 vs. − 17 ± 2%, p = 0.054), whereas GCS (− 16 ± 4 vs. − 18 ± 4%, p < 0.05) and GRS increased (39 ± 11 vs. 44 ± 11%, p < 0.01). Post-race right ventricular GLS (− 19 ± 3 vs. − 19 ± 3%, p = 0.668) remained constant and GCS increased (− 7 ± 2 vs. − 8 ± 3%, p < 0.001). Post-race left atrial GLS (30 ± 8 vs. 24 ± 6%, p < 0.0001) decreased while right atrial GLS remained constant (25 ± 6 vs. 24 ± 6%, p = 0.519).ConclusionsThe different alterations of post-race biventricular and biatrial strain might constitute an intrinsic compensatory mechanism following an acute bout of endurance exercise. The combined use of strain parameters may allow a better characterization of ventricular and atrial function in endurance athletes.Key Points• Triathletes demonstrate a decrease of LV global longitudinal strain by tendency and constant RV global longitudinal strain following an endurance race.• Post-race LV and RV global circumferential and radial strains increase, possibly indicating a compensatory mechanism after an acute endurance exercise bout.• Subgroup analyses of male triathletes with focal myocardial fibrosis did not demonstrate alterations in biventricular and biatrial strain after an endurance race.

Highlights

Numerous studies have reported on cardiac adaptations in endurance athletes [1,2,3], yet standard parameters of systolic function such as left ventricular ejection fraction (LVEF) might not detect subtle functional alterations of the athlete’s heart
Long-axis 4-chamber and three short-axis series were used to calculate right ventricular (RV) Global systolic longitudinal (GLS) and GCS (Fig. 1c, d); long-axis 4-chamber series were applied for RV free wall (FW) GLS [17]
The major findings are as follows: (1) Left ventricular GLS was slightly reduced, whereas GCS and global radial strain (GRS) increased following an endurance race; (2) Right ventricular GLS and free wall longitudinal strain remained constant, whereas GCS increased post-race; (3) Left atrial longitudinal strain was decreased post-race, and right atrial longitudinal strain remained constant; and (4) Male triathletes with focal myocardial fibrosis (LGE +) had constant baseline and post-race biventricular and biatrial strain parameters

Summary

Introduction

Numerous studies have reported on cardiac adaptations in endurance athletes [1,2,3], yet standard parameters of systolic function such as left ventricular ejection fraction (LVEF) might not detect subtle functional alterations of the athlete’s heart. While normal values of ventricular and atrial strain in endurance athletes at rest are largely undefined, echocardiographic and CMR studies report that prolonged endurance training is associated with attenuated myocardial strain compared with sedentary controls, whereas biventricular ejection fractions are similar [6,7,8,9,10]. The acute changes of myocardial strain in response to an endurance race are less well studied. Christou et al showed that the absolute values of both ventricular longitudinal strains decreased after a race, but were still within normal range for the vast majority of athletes [13]

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