Post-marathon decline in right ventricular radial motion component among amateur sportsmen

Abstract

Abstract Introduction Running the marathon may be followed by post-exercise “cardiac fatigue” manifesting as transient right ventricular (RV) systolic and diastolic impairment. It is the thin-walled RV that is predominantly affected by the exercise-induced overload, with little if any, impact on the left ventricle (LV) [1]. The 2-D echocardiographic (ECHO) assessment of RV is challenging and may be incomplete since conventional measures reflect only the longitudinal motion (displacement of tricuspid annulus towards the apex) [2]. The mechanics of RV can be separated into two more components, anteroposterior (stretching RV wall by contracting septum) and radial (internal relocation of the RV free wall) [2]. The significance and relative contribution of motion components to global RV function may not be equal, and their interplay can vary depending on concomitant diseases [3]. Purpose We aimed to analyse the pathophysiology of RV exhaustion associated with a marathon run with 3-D ECHO, which allows precise estimation of all RV motion components and their contribution to RV global function. Methods The study included 34 healthy males (mean age of 40±8 years), amateurs, who finished the marathon in northern Poland. The 3-D ECHO was performed 2 weeks before (stage I), at the marathon finish line (stage II) and 2 weeks after the competition (stage III). According to the ReVISION method (Right ventricular separate wall motion quantification) the global RV function was decomposed to longitudinal (L_), anteroposterior (AP_) and radial (R_) [3]. By dividing componential ejection fractions (EF) with global RV EF, L_EFi, AP_EFi, and R_EFi ratios were obtained. Results When comparing results from stage I and III there were no significant differences (Table 1). The analysis revealed post-run decline in RV EF with no changes in LV EF. The quantification of the RV motion components showed reduction in R_EF after the marathon with no changes in AP_EF or L_EF. The relative contribution of componential EF to global RV function were permanent and was not influenced by the competition. Conclusions Marathon run resulted in transient RV dysfunction arising from decline in radial shortening. Noteworthy, the componential interplay between wall motion compartments was preserved in pre- and post-run assessment. The ReVISION method enables the comprehensive analysis of the competing RV. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The study was supported by the project POWR.03.05.00-00-z082/18 co-financed by the European Union through the European Social Fund under the Operational Programme Knowledge Education Development 2014–2020