Skip to main content
Top
Published in: Journal of Cardiovascular Magnetic Resonance 1/2012

Open Access 01-12-2012 | Research

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

Authors: Erin Karlstedt, Anjala Chelvanathan, Megan Da Silva, Kelby Cleverley, Kanwal Kumar, Navdeep Bhullar, Matthew Lytwyn, Sheena Bohonis, Sacha Oomah, Roman Nepomuceno, Xiaozhou Du, Steven Melnyk, Matthew Zeglinski, Robin Ducas, Mehdi Sefidgar, Scott Mackenzie, Sat Sharma, Iain D Kirkpatrick, Davinder S Jassal

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2012

Login to get access

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 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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Knebel F, Schimke I, Schroeckh S, Peters H, Eddicks S, Schattke S, Brechtel L, Lock J, Wernecke KD, Dreger H, Grubitz S, Schmidt J, Baumann G, Borges AC: Myocardial function in older male amateur marathon runners: assessment by tissue Doppler echocardiography, speckle tracking, and cardiac biomarkers. J Am Soc Echocardiogr. 2009 Jul, 22 (7): 803-809. 10.1016/j.echo.2009.04.009.CrossRefPubMed Knebel F, Schimke I, Schroeckh S, Peters H, Eddicks S, Schattke S, Brechtel L, Lock J, Wernecke KD, Dreger H, Grubitz S, Schmidt J, Baumann G, Borges AC: Myocardial function in older male amateur marathon runners: assessment by tissue Doppler echocardiography, speckle tracking, and cardiac biomarkers. J Am Soc Echocardiogr. 2009 Jul, 22 (7): 803-809. 10.1016/j.echo.2009.04.009.CrossRefPubMed
2.
go back to reference Möhlenkamp S, Lehmann N, Breuckmann F, Bröcker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jöckel KH, Erbel R: Marathon Study Investigators; Heinz Nixdorf Recall Study Investigators. Running: the risk of coronary events: Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J. 2008 Aug, 29 (15): 1903-1910. 10.1093/eurheartj/ehn163.CrossRefPubMed Möhlenkamp S, Lehmann N, Breuckmann F, Bröcker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jöckel KH, Erbel R: Marathon Study Investigators; Heinz Nixdorf Recall Study Investigators. Running: the risk of coronary events: Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J. 2008 Aug, 29 (15): 1903-1910. 10.1093/eurheartj/ehn163.CrossRefPubMed
3.
go back to reference Middleton N, Shave R, George K, Whyte G, Hart E, Oxborough D, Forster J, Gaze D: Altered left ventricular diastolic filling following a marathon is a reproducible phenomenon. Int J Cardiol. 2007, 122 (1): 87-89. 10.1016/j.ijcard.2006.11.042.CrossRefPubMed Middleton N, Shave R, George K, Whyte G, Hart E, Oxborough D, Forster J, Gaze D: Altered left ventricular diastolic filling following a marathon is a reproducible phenomenon. Int J Cardiol. 2007, 122 (1): 87-89. 10.1016/j.ijcard.2006.11.042.CrossRefPubMed
4.
go back to reference Oxborough D, Shave R, Middleton N, Whyte G, Forster J, George K: The impact of marathon running upon ventricular function as assessed by 2D, Doppler, and tissue-Doppler echocardiography. Echocardiography. 2006, 23 (8): 635-641. 10.1111/j.1540-8175.2006.00282.x.CrossRefPubMed Oxborough D, Shave R, Middleton N, Whyte G, Forster J, George K: The impact of marathon running upon ventricular function as assessed by 2D, Doppler, and tissue-Doppler echocardiography. Echocardiography. 2006, 23 (8): 635-641. 10.1111/j.1540-8175.2006.00282.x.CrossRefPubMed
5.
go back to reference Kean AJ, McCloskey VR, Seghatol FF, Ewert GD, Mehlman DJ, McPherson DD, Rigolin VH: Preservation of ventricular function in amateur athletes after completion of a marathon. J Am Soc Echocardiogr. 2006 Feb, 19 (2): 202-205. 10.1016/j.echo.2005.08.013.CrossRefPubMed Kean AJ, McCloskey VR, Seghatol FF, Ewert GD, Mehlman DJ, McPherson DD, Rigolin VH: Preservation of ventricular function in amateur athletes after completion of a marathon. J Am Soc Echocardiogr. 2006 Feb, 19 (2): 202-205. 10.1016/j.echo.2005.08.013.CrossRefPubMed
6.
go back to reference Neilan TG, Januzzi JL, Lee-Lewandrowski E, Ton-Nu TT, Yoerger DM, Jassal DS, Lewandrowski KB, Siegel AJ, Marshall JE, Douglas PS, Lawlor D, Picard MH, Wood MJ: Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation. 2006, 114 (22): 2325-2333. 10.1161/CIRCULATIONAHA.106.647461.CrossRefPubMed Neilan TG, Januzzi JL, Lee-Lewandrowski E, Ton-Nu TT, Yoerger DM, Jassal DS, Lewandrowski KB, Siegel AJ, Marshall JE, Douglas PS, Lawlor D, Picard MH, Wood MJ: Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation. 2006, 114 (22): 2325-2333. 10.1161/CIRCULATIONAHA.106.647461.CrossRefPubMed
7.
go back to reference Jassal DS, Moffat D, Krahn J, Ahmadie R, Fang T, Eschun G, Sharma S: Cardiac injury markers in non-elite marathon runners. Int J Sports Med. 2009, 30 (2): 75-79. 10.1055/s-0028-1104572.CrossRefPubMed Jassal DS, Moffat D, Krahn J, Ahmadie R, Fang T, Eschun G, Sharma S: Cardiac injury markers in non-elite marathon runners. Int J Sports Med. 2009, 30 (2): 75-79. 10.1055/s-0028-1104572.CrossRefPubMed
8.
go back to reference Scharhag J, Herrmann M, Urhausen A, Haschke M, Herrmann W, Kindermann W: Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise. Am Heart J. 2005, 150 (6): 1128-1134. 10.1016/j.ahj.2005.01.051.CrossRefPubMed Scharhag J, Herrmann M, Urhausen A, Haschke M, Herrmann W, Kindermann W: Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise. Am Heart J. 2005, 150 (6): 1128-1134. 10.1016/j.ahj.2005.01.051.CrossRefPubMed
9.
go back to reference Shave R, George KP, Atkinson G, Hart E, Middleton N, Whyte G, Gaze D, Collinson PO: Exercise-induced cardiac troponin T release: a meta-analysis. Med Sci Sports Exerc. 2007, 39 (12): 2099-2106. 10.1249/mss.0b013e318153ff78.CrossRefPubMed Shave R, George KP, Atkinson G, Hart E, Middleton N, Whyte G, Gaze D, Collinson PO: Exercise-induced cardiac troponin T release: a meta-analysis. Med Sci Sports Exerc. 2007, 39 (12): 2099-2106. 10.1249/mss.0b013e318153ff78.CrossRefPubMed
10.
go back to reference Douglas PS, O’Toole ML, Hiller WD, Reichek N: Different effects of prolonged exercise on the right and left ventricles. J Am Coll Cardiol. 1990, 15 (1): 64-69. 10.1016/0735-1097(90)90176-P.CrossRefPubMed Douglas PS, O’Toole ML, Hiller WD, Reichek N: Different effects of prolonged exercise on the right and left ventricles. J Am Coll Cardiol. 1990, 15 (1): 64-69. 10.1016/0735-1097(90)90176-P.CrossRefPubMed
11.
go back to reference Mousavi N, Czarnecki A, Kumar K, Fallah-Rad N, Lytwyn M, Han SY, Francis A, Walker JR, Kirkpatrick ID, Neilan TG, Sharma S, Jassal DS: Relation of biomarkers and cardiac magnetic resonance imaging after marathon running. Am J Cardiol. 2009, 103 (10): 1467-1472. 10.1016/j.amjcard.2009.01.294.CrossRefPubMed Mousavi N, Czarnecki A, Kumar K, Fallah-Rad N, Lytwyn M, Han SY, Francis A, Walker JR, Kirkpatrick ID, Neilan TG, Sharma S, Jassal DS: Relation of biomarkers and cardiac magnetic resonance imaging after marathon running. Am J Cardiol. 2009, 103 (10): 1467-1472. 10.1016/j.amjcard.2009.01.294.CrossRefPubMed
12.
go back to reference Trivax JE, Franklin BA, Goldstein JA, Chinnaiyan KM, Gallagher MJ, deJong AT, Colar JM, Haines DE, McCullough PA: Acute cardiac effects of marathon running. J Appl Physiol. 2010, 108 (5): 1148-1153. 10.1152/japplphysiol.01151.2009.CrossRefPubMed Trivax JE, Franklin BA, Goldstein JA, Chinnaiyan KM, Gallagher MJ, deJong AT, Colar JM, Haines DE, McCullough PA: Acute cardiac effects of marathon running. J Appl Physiol. 2010, 108 (5): 1148-1153. 10.1152/japplphysiol.01151.2009.CrossRefPubMed
13.
go back to reference La Gerche A, Burns AT, Mooney DJ, Inder WJ, Taylor A, Bogaert J, MacIsaac AI, Heidbuchel H, Prior DL: Exercise-induced right ventricular dysfunction and structural remodeling in endurance athletes. Eur Heart J. 2012, 33: 998-1006. 10.1093/eurheartj/ehr397.CrossRefPubMed La Gerche A, Burns AT, Mooney DJ, Inder WJ, Taylor A, Bogaert J, MacIsaac AI, Heidbuchel H, Prior DL: Exercise-induced right ventricular dysfunction and structural remodeling in endurance athletes. Eur Heart J. 2012, 33: 998-1006. 10.1093/eurheartj/ehr397.CrossRefPubMed
14.
go back to reference Breuckmann F, Möhlenkamp S, Nassenstein K, Lehmann N, Ladd S, Schmermund A, Sievers B, Schlosser T, Jöckel KH, Heusch G, Erbel R, Barkhausen J: Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners. Radiology. 2009, 251 (1): 50-57. 10.1148/radiol.2511081118.CrossRefPubMed Breuckmann F, Möhlenkamp S, Nassenstein K, Lehmann N, Ladd S, Schmermund A, Sievers B, Schlosser T, Jöckel KH, Heusch G, Erbel R, Barkhausen J: Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners. Radiology. 2009, 251 (1): 50-57. 10.1148/radiol.2511081118.CrossRefPubMed
15.
go back to reference Hanssen H, Keithahn A, Hertel G, Drexel V, Stern H, Schuster T, Lorang D, Beer AJ, Schmidt-Trucksass A, Nickel T, Weis M, Botnar R, Schwaiger M, Halle M: Magnetic resonance imaging of myocardial injury and ventricular torsion after marathon running. Clin Sci (Lond). 2011, 120 (4): 143-152. 10.1042/CS20100206.CrossRef Hanssen H, Keithahn A, Hertel G, Drexel V, Stern H, Schuster T, Lorang D, Beer AJ, Schmidt-Trucksass A, Nickel T, Weis M, Botnar R, Schwaiger M, Halle M: Magnetic resonance imaging of myocardial injury and ventricular torsion after marathon running. Clin Sci (Lond). 2011, 120 (4): 143-152. 10.1042/CS20100206.CrossRef
16.
go back to reference O’Hanlon R, Wilson M, Wage R, Smith G, Alpendurada FD, Wong J, Dahl A, Oxborough D, Godfrey R, Sharma S, Roughton M, George K, Pennell DJ, Whyte G, Prasad SK: Troponin release following endurance exercise: Is inflammation the cause? a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2010, 12: 38-10.1186/1532-429X-12-38.PubMedCentralCrossRefPubMed O’Hanlon R, Wilson M, Wage R, Smith G, Alpendurada FD, Wong J, Dahl A, Oxborough D, Godfrey R, Sharma S, Roughton M, George K, Pennell DJ, Whyte G, Prasad SK: Troponin release following endurance exercise: Is inflammation the cause? a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2010, 12: 38-10.1186/1532-429X-12-38.PubMedCentralCrossRefPubMed
17.
go back to reference Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St. John Sutton M, Stewart W: Recommendations for chamber quantification. Eur J Echocardiogr. 2006, 7 (2): 79-108. 10.1016/j.euje.2005.12.014.CrossRefPubMed Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St. John Sutton M, Stewart W: Recommendations for chamber quantification. Eur J Echocardiogr. 2006, 7 (2): 79-108. 10.1016/j.euje.2005.12.014.CrossRefPubMed
18.
go back to reference Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB: Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010, 23 (7): 685-713. 10.1016/j.echo.2010.05.010.CrossRefPubMed Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB: Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010, 23 (7): 685-713. 10.1016/j.echo.2010.05.010.CrossRefPubMed
19.
go back to reference Oxborough D, Shave R, Warburton D, Wiliams K, Oxborough A, Charlesworth S, Foulds H, Hoffman MD, Birch K, George K: Dilatation and dysfunction of the right ventricle immediately after ultraendurance exercise: exploratory insights from conventional two-dimensional and speckle tracking echocardiography. Circ Cardiovasc Res. 2011, 4: 253-256.CrossRef Oxborough D, Shave R, Warburton D, Wiliams K, Oxborough A, Charlesworth S, Foulds H, Hoffman MD, Birch K, George K: Dilatation and dysfunction of the right ventricle immediately after ultraendurance exercise: exploratory insights from conventional two-dimensional and speckle tracking echocardiography. Circ Cardiovasc Res. 2011, 4: 253-256.CrossRef
20.
go back to reference Neumayr G, Pfister R, Mitterbauer G, Eibl G, Hoertnagl H: Effect of competitive marathon cycling on plasma N-terminal pro-brain natriuretic peptide and cardiac troponin T in healthy recreational cyclists. Am J Cardiol. 2005 Sep, 96 (5): 732-735. 10.1016/j.amjcard.2005.04.054.CrossRefPubMed Neumayr G, Pfister R, Mitterbauer G, Eibl G, Hoertnagl H: Effect of competitive marathon cycling on plasma N-terminal pro-brain natriuretic peptide and cardiac troponin T in healthy recreational cyclists. Am J Cardiol. 2005 Sep, 96 (5): 732-735. 10.1016/j.amjcard.2005.04.054.CrossRefPubMed
21.
go back to reference Urhausen A, Scharhag J, Herrmann M, Kindermann W: Clinical significance of increased cardiac troponins T and I in participants of ultra-endurance events. Am J Cardiol. 2004 Sep, 94 (5): 696-698. 10.1016/j.amjcard.2004.05.050.CrossRefPubMed Urhausen A, Scharhag J, Herrmann M, Kindermann W: Clinical significance of increased cardiac troponins T and I in participants of ultra-endurance events. Am J Cardiol. 2004 Sep, 94 (5): 696-698. 10.1016/j.amjcard.2004.05.050.CrossRefPubMed
22.
go back to reference Katus HA, Remppis A, Scheffold T, Diederich KW, Kuebler W: Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. Am J Cardiol. 1991 Jun, 67 (16): 1360-1367. 10.1016/0002-9149(91)90466-X.CrossRefPubMed Katus HA, Remppis A, Scheffold T, Diederich KW, Kuebler W: Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. Am J Cardiol. 1991 Jun, 67 (16): 1360-1367. 10.1016/0002-9149(91)90466-X.CrossRefPubMed
23.
go back to reference Chen Y, Serfass RC, Mackey-Bojack SM, Kelly KL, Titus JL, Apple FS: Cardiac troponin T alterations in myocardium and serum of rats after stressful, prolonged intense exercise. J Appl Physiol. 2000 May, 88 (5): 1749-1755.PubMed Chen Y, Serfass RC, Mackey-Bojack SM, Kelly KL, Titus JL, Apple FS: Cardiac troponin T alterations in myocardium and serum of rats after stressful, prolonged intense exercise. J Appl Physiol. 2000 May, 88 (5): 1749-1755.PubMed
24.
go back to reference Christiansen JP, Edwards C, Sinclair T, Armstrong G, Scott A, Patel H, Hart H: Detection of myocardial scar by contrast-enhanced cardiac magnetic resonance imaging in patients with troponin-positive chest pain and minimal angiographic coronary artery disease. Am J Cardiol. 2006, 97 (6): 768-771. 10.1016/j.amjcard.2005.10.016.CrossRefPubMed Christiansen JP, Edwards C, Sinclair T, Armstrong G, Scott A, Patel H, Hart H: Detection of myocardial scar by contrast-enhanced cardiac magnetic resonance imaging in patients with troponin-positive chest pain and minimal angiographic coronary artery disease. Am J Cardiol. 2006, 97 (6): 768-771. 10.1016/j.amjcard.2005.10.016.CrossRefPubMed
25.
go back to reference Selvanayagam JB, Porto I, Channon K, Petersen SE, Francis JM, Neubauer S, Banning AP: Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury: insights from cardiovascular magnetic resonance imaging. Circulation. 2005 Mar, 111 (8): 1027-1032. 10.1161/01.CIR.0000156328.28485.AD.CrossRefPubMed Selvanayagam JB, Porto I, Channon K, Petersen SE, Francis JM, Neubauer S, Banning AP: Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury: insights from cardiovascular magnetic resonance imaging. Circulation. 2005 Mar, 111 (8): 1027-1032. 10.1161/01.CIR.0000156328.28485.AD.CrossRefPubMed
26.
go back to reference Wilson M, O’Hanlon R, Prasad S, Deighan A, Macmillan P, Oxborough D, Godfrey R, Smith G, Maceira A, Sharma S, George K, Whyte G: Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes. J Appl Physiol. 2011, 110 (6): 1622-1626. 10.1152/japplphysiol.01280.2010.PubMedCentralCrossRefPubMed Wilson M, O’Hanlon R, Prasad S, Deighan A, Macmillan P, Oxborough D, Godfrey R, Smith G, Maceira A, Sharma S, George K, Whyte G: Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes. J Appl Physiol. 2011, 110 (6): 1622-1626. 10.1152/japplphysiol.01280.2010.PubMedCentralCrossRefPubMed
Metadata
Title
The impact of repeated marathon running on cardiovascular function in the aging population
Authors
Erin Karlstedt
Anjala Chelvanathan
Megan Da Silva
Kelby Cleverley
Kanwal Kumar
Navdeep Bhullar
Matthew Lytwyn
Sheena Bohonis
Sacha Oomah
Roman Nepomuceno
Xiaozhou Du
Steven Melnyk
Matthew Zeglinski
Robin Ducas
Mehdi Sefidgar
Scott Mackenzie
Sat Sharma
Iain D Kirkpatrick
Davinder S Jassal
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2012
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/1532-429X-14-58

Other articles of this Issue 1/2012

Journal of Cardiovascular Magnetic Resonance 1/2012 Go to the issue