Aims Endurance training may be associated with arrhythmogenic cardiac remodelling of the right ventricle (RV). We examined whether myocardial dysfunction following intense endurance exercise affects the RV more than the left ventricle (LV) and whether cumulative exposure to endurance competition influences cardiac remodelling (including fibrosis) in well-trained athletes.

Methods and results Forty athletes were studied at baseline, immediately following an endurance race (3–11 h duration) and 1-week post-race. Evaluation included cardiac troponin (cTnI), B-type natriuretic peptide, and echocardiography [including three-dimensional volumes, ejection fraction (EF), and systolic strain rate]. Delayed gadolinium enhancement (DGE) on cardiac magnetic resonance imaging (CMR) was assessed as a marker of myocardial fibrosis. Relative to baseline, RV volumes increased and all functional measures decreased post-race, whereas LV volumes reduced and function was preserved. B-type natriuretic peptide (13.1 ± 14.0 vs. 25.4 ± 21.4 ng/L, P = 0.003) and cTnI (0.01 ± .03 vs. 0.14 ± .17 μg/L, P < 0.0001) increased post-race and correlated with reductions in RVEF ( r = 0.52, P = 0.001 and r = 0.49, P = 0.002, respectively), but not LVEF. Right ventricular ejection fraction decreased with increasing race duration ( r = −0.501, P < 0.0001) and VO2max ( r = −0.359, P = 0.011). Right ventricular function mostly recovered by 1 week. On CMR, DGE localized to the interventricular septum was identified in 5 of 39 athletes who had greater cumulative exercise exposure and lower RVEF (47.1 ± 5.9 vs. 51.1 ± 3.7%, P = 0.042) than those with normal CMR.

Conclusion Intense endurance exercise causes acute dysfunction of the RV, but not the LV. Although short-term recovery appears complete, chronic structural changes and reduced RV function are evident in some of the most practiced athletes, the long-term clinical significance of which warrants further study.

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Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes

IntroductionProlonged intense exercise has often been associated with the impairment of right ventricular (RV) function after activity, whereas this is rare for the left ventricle (LV). The effect of prolonged exercise on the heart has not been adequately measured during exercise itself.Meth

Right ventricular fatigue developing during endurance exercise: an exercise cardiac magnetic resonance study.

We examined the effect of intensity during prolonged exercise (PE) on left (LV) and right ventricular (RV) function. Subjects included 18 individuals (mean ± SE: age = 28.1 ± 1.1 yr, maximal aerobi...

Impaired left and right ventricular function following prolonged exercise in young athletes: influence of exercise intensity and responses to dobutamine stress.

High-intensity exercise induces marked physiological stress affecting the secretion of catecholamines. Sustained elevations in catecholamines are thought to desensitize cardiac beta receptors and m...

https://www.physiology.org/doi/pdf/10.1152/japplphysiol.00576.2013

Left ventricular mechanics and arterial-ventricular coupling following high-intensity interval exercise

An acute reduction in blood pressure observed after a single bout of exercise is termed post-exercise hypotension (PEH). In contrast to moderate intensity aerobic exercise, little is known about the PEH response following high-intensity interval exercise. The present purpose is to assess how sex and training status impact PEH following high-intensity interval exercise. Cardiac volumes and function via echocardiography were measured in 40 normotensive, endurance-trained (ET) and normally active (NA) men and women (Age ± SD = 30.5 ± 5.7) following high-intensity interval cycle exercise. Continuous measurements of ECG and beat-by-beat blood pressure were collected before and 30 min post-exercise for determination of cardiovagal baroreflex function (BRS and αLF), spectral analysis of heart rate and systolic blood pressure (SBP LF). Post-exercise systolic BP was significantly reduced from baseline, occurring to a greater degree in ET compared with NA (−12.9 vs. −5.3 mmHg, P = 0.008), while mean arterial pressure was similarly reduced in all groups (−4.6 mmHg, P = 0.003). Despite reduced SVI and TPRI, CI was increased post-exercise (P < 0.01). ET experienced a greater decrease in αLF (P = 0.037) and increase in SBP LF (P = 0.017) than NA. Lean body mass was a significant predictor of change in SBP LF (Std. β = 0.735, P = 0.008). These results characterize greater depressions in cardiovagal baroreflex function, and increased sympathetic activity, following vigorous exercise in endurance-trained individuals compared with normally active participants. This heightened sympathovagal balance after high-intensity exercise may be a compensatory mechanism in response to greater peripheral blood flow demands following vigorous exercise.

Greater autonomic modulation during post-exercise hypotension following high-intensity interval exercise in endurance-trained men and women.

We examined left ventricular (LV) performance before, during, and following prolonged exercise (EX) in 12 healthy middle-aged men [means ± SE: age = 43.5 ± 1.9 yr; maximal O2 uptake (Vo2max) = 51....

https://www.physiology.org/doi/pdf/10.1152/japplphysiol.90506.2008

Left ventricular contractile function is preserved during prolonged exercise in middle-aged men

This study sought to determine the influence of age on the left ventricular (LV) response to prolonged exercise (PE; 150 min). LV systolic and diastolic performance was assessed using echocardiogra...

Cardiac function following prolonged exercise: influence of age

during prolonged exercise in middle-aged men Left ventricular contractile function is preserved

influence of age Cardiac function following prolonged exercise

strenuous exercise -receptor responsiveness following prolonged β Sex differences in left ventricular function and

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