Dilatation and dysfunction of the right ventricle immediately after ultraendurance exercise: exploratory insights from conventional two-dimensional and speckle tracking echocardiography

Abstract

Background—Running an ultramarathon has been shown to have a transient negative effect upon RV and LV function. Also, recent findings have suggested that ultra-endurance athletes may be more at risk of developing a "RV cardiomyopathy". The standard echocardiographic assessment of RV function is problematic; however, the introduction of ultrasonic speckle tracking technology provides potential for a comprehensive evaluation of RV longitudinal function providing new insights into this phenomenon. In view of this, the primary aim of this exploratory study was to evaluate comprehensively right ventricular (RV) structure and function following a 161-km ultramarathon and establish if changes in the RV are associated with alterations in left ventricular (LV) function.

Methods and Results—Myocardial speckle tracking echocardiograms of the RV and LV were obtained prior to and immediately following a 161-km ultramarathon in 16 healthy adults. Standard echocardiography was used to determine RV size and function and LV eccentricity index (LVEI). Speckle tracking was used to determine the temporal evaluation of indices of RV and LV function. RV size was significantly increased post-race (RV outflow 32 to 35mm, p=0.002 and RV inflow 42 to 45mm, p=0.027) with an increase in LVEI (1.03 to 1.13, p=0.006). RV strain (ϵ) was significantly reduced post-race (-27 to -24%, p=0.004) but there was no change in the rates of ϵ. Peak ϵ in all planes of LV motion were reduced post-race (longitudinal, -18.3 to -16.3%, p=0.012; circumferential, -20.2 to -15.7%, p=0.001; and radial 53.4 to 40.3%, p=0.009). Changes in RV size and function correlated with diastolic strain rates in the LV.

Conclusions—This exploratory study demonstrates RV dilatation and reduction in function following an ultramarathon. Further research is warranted to elucidate the mechanisms responsible for these findings. It is not clear what clinical impact might result from consecutive bouts of post-exercise RV dysfunction.