Clinical Investigation
Exercise and Cardiac Function
Myocardial Function in Older Male Amateur Marathon Runners: Assessment by Tissue Doppler Echocardiography, Speckle Tracking, and Cardiac Biomarkers

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Background

Participation of older men in endurance races continues to increase. Recent studies on marathon runners raised concerns about a transient myocardial dysfunction and damage. The aim of our study was to compare the extent of marathon-induced myocardial dysfunction in young and older runners and to identify its potential correlation to elevated cardiac biomarkers.

Methods

Twenty-eight older (aged 60-72 years) and 50 younger (22-59 years) male amateur athletes who participated in the 2006 Berlin Marathon were included in the study and examined by echocardiography (including tissue Doppler and speckle tracking echocardiography) and blood tests (including troponin T [TnT], N-terminal pro brain natriuretic peptide [NT-proBNP]) before, immediately after, and 2 weeks after the race.

Results

Immediately after the marathon, there was no sign of systolic myocardial dysfunction (increase in fractional shortening, baseline 39.9% ± 7.6% vs post 46.8% ± 9.2%, P < .001, unchanged septal basal longitudinal 2-dimensional strain: 17.1% ± 2.9%, 17.7% ± 3.2%, P = .11). As a marker of diastolic function, E/E' was not altered significantly (7.6 ± 2.1, 8.7 ± 3.5, P = .15). The deceleration time of E and E' decreased in both groups immediately after the race, indicating a transient adaptation of diastolic myocardial function. Strain of the right ventricular free wall was decreased in the mid and apical segments after the race in both groups with normalization during follow-up. Tricuspid annular plane systolic excursion was not altered. Some 53.8% of all runners had increases in TnT or NT-proBNP after the race. Some 32% of controls and 29% of older runners had elevated levels of NT-proBNP (P = .75, TnT: 44% vs 29% P = .18). There was no correlation between NT-proBNP and TnT increase. The increases in biomarkers were not correlated to echocardiography parameters of systolic, diastolic, or right-sided heart dysfunction or to age, training level, running time, or renal function. All parameters returned to normal ranges after 2 weeks.

Conclusion

Left ventricular systolic function is preserved after a marathon in older runners. There are right ventricular functional changes as a sign of prolonged myocardial work load. There is no significant difference between older and young runners regarding transient diastolic dysfunction or biomarker release. The latter is not associated with echocardiography parameters of myocardial dysfunction.

Section snippets

Study Design

This prospective study aimed to enroll older runners and young controls. The organizers of the 2006 Berlin Marathon invited all registered male contestants from the Berlin-Brandenburg area by e-mail to participate in our study. Of more than 500 positive responses, the first 88 runners were screened and enrolled in the study. The maximum number of participants was limited by the logistics immediately after the race. Written informed consent was obtained from each participant. The ethics

Results

The 33rd real,-Berlin Marathon took place on September 24, 2006. At noon, the temperature was 23.5°C and the relative humidity was 46%. Seventy-eight white male participants (age range, 22-72 years), divided into an older group (≥60 years, range 60-72 years, n = 28, mean 63 ± 3 years) and a group of younger controls (≤59 years, range 22-59 years, n = 50, mean 46 ± 12 years), finished the race.

All runners completed the marathon without relevant medical problems. The older runners did not differ

Discussion

Marathon running in well-trained older athletes does not induce right or left-sided heart dysfunction. Young and older runners' echocardiographic changes are statistically equivalent. However, there is an age-independent adaptation of diastolic function, most likely due to dehydration. The biomarker increases in some runners are not associated with any echocardiography parameter. To our knowledge, our report is the largest prospective study on changes of myocardial biomarkers and

Limitations

The times of blood withdrawal and echocardiography were not at identical time points after the start of the race because of different finish times. The older runners needed significantly more time to complete the race. Furthermore, we cannot differentiate between increased membrane permeability and myocardial ischemia by the cardiac biomarkers used.

Conclusions

Running a marathon does not induce a relevant systolic left or right-sided heart dysfunction. There were age-independent alterations in diastolic function after a marathon that were not associated with increases in cardiac biomarkers. These changes are probably due to dehydration and tachycardia. There was a temporary increase in biomarkers (NT-proBNP and TnT) in some runners with no correlation to age, training level, running time, or renal function. This study suggests that running a marathon

Acknowledgments

We thank Rüdiger Otto, managing director of the real,-Berlin Marathon, for the permission to perform the study. We thank all the runners who have participated in the study. We are grateful to Dr Marko Boehm, Wasiem Sanad, Dr Andrea Grohmann, Dr Mark Beling, Dr Gerda Siebert, Christine Scholz, Claudia Kuhn, Dr Petra Schroeckh, Maximilian Franke, Cornelia Köbe, Wolfgang Köbe, Jennifer Köbe, Kim Tae-Hyoung, Thorsten Reichstein, Julia Hubner, and Christoph Schöbel for support. We are grateful to

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