Post-marathon Decline in Right Ventricular Radial Motion Component Among Amateur Sportsmen.

Zuzanna Lewicka-Potocka,Ewa Lewicka,Marcin Kubik,Anna Faran,Anna Maria Kaleta-Duss,Grzegorz Raczak,Alicja Da̧Browska-Kugacka,Paweł Szymeczko,Rafał Gała̧Ska

doi:10.3389/fphys.2021.811764

Zuzanna Lewicka-Potocka, Ewa Lewicka + Show 7 more

Open Access

https://doi.org/10.3389/fphys.2021.811764

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Abstract

Moderate physical activity has a positive impact on health, although extreme forms of sport such as marathon running may trigger exercise-induced cardiac fatigue. The explicit distinction between the right ventricular (RV) physiological response to training and maladaptive remodeling has not yet been determined. In this study, we aimed to analyze the impact of running a marathon on RV mechanics in amateur athletes using three-dimensional (3D) echocardiography (ECHO) and the ReVISION method (RV separate wall motion quantification). A group of 34 men with a mean age of 40 ± 8 years who successfully finished a marathon underwent ECHO three times, i.e., 2 weeks before the marathon (stage I), at the marathon finish line (stage II), and 2 weeks after the marathon (stage III). The ECHO findings were then correlated with the concentrations of biomarkers related to myocardial injury and overload and also obtained at the three stages. On finishing the marathon, the amateur athletes were found to have a significant (p < 0.05) increase in end-diastolic (with a median of 51.4 vs. 57.0 ml/m2) and end-systolic (with a median of 24.9 vs. 31.5 ml/m2) RV volumes indexed to body surface area, reduced RV ejection fraction (RVEF) (with a median of 51.0% vs. 46.0%), and a decrease in RV radial shortening [i.e., radial EF (REF)] (with a mean of 23.0 ± 4.5% vs. 19.3 ± 4.2%), with other RV motion components remaining unchanged. The post-competition decrease in REF was more evident in runners with larger total volume of trainings (R2 = 0.4776, p = 0.0002) and higher concentrations of high-sensitivity cardiac troponin I (r = 0.43, p < 0.05) during the preparation period. The decrease in REF was more prominent in the training of marathoners more than 47 km/week. At stage II, marathoners with a more marked decrease in RVEF and REF had higher galectin-3 (Gal-3) levels (r = −0.48 and r = −0.39, respectively; p < 0.05). Running a marathon significantly altered the RV performance of amateur athletes. Transient impairment in RV systolic function resulted from decreased radial shortening, which appeared in those who trained more extensively. Observed ECHO changes correlated with the concentrations of the profibrotic marker Gal-3.

Highlights

Regular physical activity has many well-documented health benefits (Nystoriak and Bhatnagar, 2018), a reduction in all-cause mortality (Pelliccia et al, 2021)
The results on the biochemical analysis between study stages and changes in the concentrations of cardiovascular biomarkers expressed as mean ± SD have been described in detail recently (Kaleta-Duss et al, 2020)
The echocardiographic findings of the modified right ventricular (RV) mechanics were reflected on the biochemical level, as significant correlations were found with the profibrotic marker of cardiac remodeling, Gal-3

Summary

Introduction

Regular physical activity has many well-documented health benefits (Nystoriak and Bhatnagar, 2018), a reduction in all-cause mortality (Pelliccia et al, 2021). The growing popularity of long-distance running competitions has been observed (Nikolaidis et al, 2018). The minimum weekly amount of moderate- and vigorous-intensity exercise for healthy adults is known (Pelliccia et al, 2021), the beneficial upper level of sports activity is not defined. Preparing to run a marathon requires many hours of intense training. Due to the different compensatory capacities of the pulmonary vascular bed and systemic circuit, the increase in pulmonary artery pressure is disproportionately greater, and exercise-induced overload predominantly affects the right ventricle (RV) (La Gerche et al, 2014). Some researchers even suggested that there is a risk of developing “exercise-induced arrhythmogenic RV cardiomyopathy,” among possible long-term consequences of repetitive bouts of intensive training (Heidbuchel et al, 2012). There is still ongoing discussion about the boundary between physiological adaptation to exercise and pathological RV remodeling (Leischik et al, 2020)

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