The impact of repeated marathon running on cardiovascular function in the aging population

Chelvanathan Anjala, Cleverley Kelby, Bhullar Navdeep, Sefidgar Mehdi, Karlstedt Erin, Ad, Kumar Kanwal, Lytwyn Matthew, Bohonis Sheena, Oomah Sacha, Nepomuceno Roman, Du Xiaozhou, Melnyk Steven, Zeglinski Matthew, Ducas Robin, Mackenzie Scott, Sharma Sat, Kirkpatrick, Jassal

Description

Several studies have correlated elevations in cardiac biomarkers of injury post marathon with transient and reversible right ventricular (RV) systolic dysfunction as assessed by both transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR). Whether or not permanent myocardial injury occurs due to repeated marathon running in the aging population remains controversial. Objectives To assess the extent and severity of cardiac dysfunction after the completion of full marathon running in individuals greater than 50 years of age using cardiac biomarkers, TTE, cardiac computed tomography (CCT), and CMR. Methods A total of 25 healthy volunteers (21 males, 55 ± 4 years old) from the 2010 and 2011 Manitoba Full Marathons (26.2 miles) were included in the study. Cardiac biomarkers and TTE were performed one week prior to the marathon, immediately after completing the race and at one-week follow-up. CMR was performed at baseline and within 24 hours of completion of the marathon, followed by CCT within 3 months of the marathon. Results All participants demonstrated an elevated cTnT post marathon. Right atrial and ventricular volumes increased, while RV systolic function decreased significantly immediately post marathon, returning to baseline values one week later. Of the entire study population, only two individuals demonstrated late gadolinium enhancement of the subendocardium in the anterior wall of the left ventricle, with evidence of stenosis of the left anterior descending artery on CCT. Conclusions Marathon running in individuals over the age of 50 is associated with a transient, yet reversible increase in cardiac biomarkers and RV systolic dysfunction. The presence of myocardial fibrosis in older marathon athletes is infrequent, but when present, may be due to underlying occult coronary artery disease.

Sujets

• Echocardiography
• Cardiovascular magnetic resonance imaging

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 22
• Langue: English

Extrait

Karlstedt et al. Journal of Cardiovascular Magnetic Resonance 2012, 14:58
http://www.jcmr-online.com/content/14/1/58
RESEARCH Open Access
The impact of repeated marathon running on
cardiovascular function in the aging population
1 2 1 1 3 1Erin Karlstedt , Anjala Chelvanathan , Megan Da Silva , Kelby Cleverley , Kanwal Kumar , Navdeep Bhullar ,
1 1 1 1 1 1Matthew Lytwyn , Sheena Bohonis , Sacha Oomah , Roman Nepomuceno , Xiaozhou Du , Steven Melnyk ,
1 2 4 4 5 6 Zeglinski , Robin Ducas , Mehdi Sefidgar , Scott Mackenzie , Sat Sharma , Iain D Kirkpatrick
1,2,6*and Davinder S Jassal
Abstract
Background: Several studies have correlated elevations in cardiac biomarkers of injury post marathon with
transient and reversible right ventricular (RV) systolic dysfunction as assessed by both transthoracic
echocardiography (TTE) and cardiovascular magnetic resonance (CMR). Whether or not permanent myocardial
injury occurs due to repeated marathon running in the aging population remains controversial.
Objectives: To assess the extent and severity of cardiac dysfunction after the completion of full marathon running
in individuals greater than 50 years of age using biomarkers, TTE, cardiac computed tomography (CCT),
and CMR.
Methods: A total of 25 healthy volunteers (21 males, 55±4 years old) from the 2010 and 2011 Manitoba Full
Marathons (26.2 miles) were included in the study. Cardiac biomarkers and TTE were performed one week prior to
the marathon, immediately after completing the race and at one-week follow-up. CMR was performed at baseline
and within 24 hours of completion of the marathon, followed by CCT within 3 months of the marathon.
Results: All participants demonstrated an elevated cTnT post marathon. Right atrial and ventricular volumes
increased, while RV systolic function decreased significantly immediately post marathon, returning to baseline
values one week later. Of the entire study population, only two individuals demonstrated late gadolinium
enhancement of the subendocardium in the anterior wall of the left ventricle, with evidence of stenosis of the left
anterior descending artery on CCT.
Conclusions: Marathon running in individuals over the age of 50 is associated with a transient, yet reversible
increase in cardiac biomarkers and RV systolic dysfunction. The presence of myocardial fibrosis in older marathon
athletes is infrequent, but when present, may be due to underlying occult coronary artery disease.
Keywords: Marathon running, Cardiac biomarkers, Echocardiography, Cardiac computed tomography,
Cardiovascular magnetic resonance
* Correspondence: [e-mail]
1
Institute of Cardiovascular Sciences, St. Boniface Research Centre, University
of Manitoba, Winnipeg, MB, Canada
2
Section of Cardiology, Department of Internal Medicine, University of
Manitoba, Rm Y3531, 409 Tache Avenue, St. Boniface General Hospital,
Winnipeg, MB, Canada
Full list of author information is available at the end of the article
© 2012 Karlstedt et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.Karlstedt et al. Journal of Cardiovascular Magnetic Resonance 2012, 14:58 Page 2 of 7
http://www.jcmr-online.com/content/14/1/58
Background Manitoba Full Marathons. Subjects over the age of 50 who
Participation in strenuous aerobic physical activity is on participated in greater than three marathons in the past
the rise in North America, especially among the aging two years, were included in the study. Exclusion criteria
population [1]. The cardiovascular effects of acute strenu- included a history of smoking, hypertension, elevated
ous exercise, specifically marathon running, has been stud- lipids, diabetes, and/or contraindications for CCT or CMR.
ied extensively over the past two decades [2-5]. A number The study protocol was approved by the local institutional
of studies involving marathon participants between the review board.
ages of 18 and 40 years, have demonstrated a transient in-
crease in cardiac biomarkers and right ventricular (RV) Cardiac biomarkers
systolic dysfunction using multimodality cardiac imaging, The cardiac biomarkers measured included myoglobin,
including transthoracic echocardiography (TTE) and car- creatinine kinase (CK), and cardiac specific troponin T
diovascular magnetic resonance (CMR) [6-12]. Little is (cTnT). These biomarkerswere measured at three separate
known, however, on the cardiovascular effects of repeated time points: (1) 1 week prior to the marathon; (2) immedi-
marathon running in individuals over theageof 50. ately after completion of the full marathon; and (3) 1 week
Although cardiac biomarkers, including cardiac specific following themarathon. Myoglobin levels were determined
TM
TnT, are transiently elevated in participants immediately using a Roche Elecsys analyzer and CK levels were
TM
following the marathon [6-12], it remains unclear whether determined using a Roche 917 analyzer. An increase in
true myocardial necrosis occurs at the cellular level. Late myoglobin and CK levels four times greater than baseline
gadolinium enhancement CMR (LGE-CMR), following ad- was considered elevated. A third generation Roche Elecsys
ministration of gadolinium, has been recently evaluated as assay was used to perform quantitative determinations of
a noninvasive method of delineating myocardial necrosis cTnT levels.
in this patient population [11-16]. In individuals between
the ages of 18 and 40, a number of recent marathon stud- Echocardiography
ies have demonstrated the absence of LGE of the left ven- All subjects underwent baselineTTE one week prior to the
tricular (LV) myocardium [11,12,15,16]. This would marathon, immediately after completion of the marathon
suggest that permanent myocardial injury does not occur and one week post marathon. Parasternal and apical views
fromrepeatedmarathon running. were obtained using a standard echocardiography machine
On the contrary, Breuckmann et al. recently demon- (GE Vivid 7, Milwaukee, Il, USA) with a multifrequency
stratedevidenceofLGEoftheLVmyocardiuminahetero- transducer and tissue Doppler capability. Standard 2-
geneous cohort of individuals greater than 50 years of age, dimensional images, M-mode, spectral and color Doppler,
suggesting myocardial injury may result from the stress of and tissue Doppler imaging (TDI)were performed.
repeated marathon running [14]. In their study, a greater Interventricular septal thickness (IVS), posterior wall
number of participants who ran marathons demonstrated thickness (PWT), left ventricular ejection fraction (LVEF),
LGE of the LV myocardium when compared to age- and left atrial (LA) size indexed to body surface area were
matched controls. Although the study excluded runners determined from 2-dimensional images [17]. Left ventricu-
withaprecedinghistoryofischemicheartdisease(IHD), lar mass was calculated using the area-length method per
thepresenceofobstructivecoronaryarterydisease(CAD) the American Society of Echocardiography guidelines [17].
was not systematically evaluated. It is entirely plausible that Right ventricular cavity dimensions, RV fractional area
the LGE of the LV myocardium observed in the runners change (FAC) and tricuspid annular plane systolic excur-
greater than 50 years of age in their patient population may sion (TAPSE) were determined [18]. Continuous-wave
have been due to underlying occult obstructive CAD, rather Doppler was used to measure the peak velocity across the
than asa direct result of repetitive marathon running. tricuspid valve and the maximal peak pressure gradient
The aims of the current study were two-fold: 1) To as- was estimated using the simplified Bernouilli equation with
sess the extent and severity of cardiac dysfunction after the addition of the right atrial pressure to calculate the pul-
completion of full marathon running in elite individuals monary artery systolic pressure (PASP) [18]. Transmitral
>50 years of age using cardiac biomarkers,TTE and CMR; LV filling velocity at the tips of the mitral valve leaflets
and 2) If there is evidence of LGE on CMR, to detect the were obtained from the apical 4-chamber view using
presence of silent coronary artery disease using cardiac pulsed wave Doppler echocardiography. Tissue Doppler
computed tomography (CCT). derived indices were recorded at the lateral mitral annulus
oftheLVandthe lateraltricuspidannulus of the RV.
Methods
Study population Cardiac computed tomography
A prospective study was performed on 25 consecutive elite All patients underwent CCT using a 64 detector-row GE
individuals who participated in the 2010 and 2011 Lightspeed VCT scanner (General Electric MedicalKarlstedt et al. Journal of Cardiovascular Magnetic Resonance 2012, 14:58 Page 3 of 7
http://www.jcmr-online.com/content/14/1/58
Systems, Milwaukee, Wi, US), within three months of (nonparametric with Dunn testing) was used to compare
completing the full marathon. A prospective ECG-gated baseline, immediate, and one week post marathon cardiac
(SnapShot Pulse, GE Medical) CTcoronary angiogram was biomarkers and echocardiographic values. A p-value <0.05
performed.Images were obtainedwith a tube rotation time was considered statistically significant. SAS version 9.02
of