Long-Term Changes in Ventricular Function in Recreational Marathon Runners

Importance The effects of long-term repetitive and strenuous exercise loads on the right ventricle and plasma troponin levels are unclear. Objective To investigate the marathon-induced increase in troponin T and its association with right ventricular remodeling after 10 years of repetitive bouts of strenuous exercise. Design, Setting, and Participants This was a longitudinal, observational cohort study (the Prospective Follow-Up, Marathon, Long-Term, Inflammation, Cardiovascular System [Pro-MagIC] study) conducted from August to December 2019. Participants were male marathon runners recruited from a single center in Germany. Exposures Repetitive strenuous exercise training and endurance competitions for 10 years. Main Outcomes and Measures Cardiac biomarkers and 3-dimensional echocardiography were assessed prerace, immediately, on days 1 and 3 postrace, and at 10-year follow-up. Results A total of 152 male runners (mean [SD] age, 43 [3] years) were included in this analysis. Right ventricular ejection fraction declined significantly from the prerace (median, 52.4%; IQR, 50.0%-55.1%) to immediate postrace (median, 47.6%; IQR, 44.7%-51.5%; P < .001) assessment and 1-day postrace (median, 50.7%; IQR, 48.4%-53.0%; P = .001) but recovered at 3-day postrace (median, 51.3%; IQR, 50.4%-53.0%; P = .18); it also recovered to the prerace level even at the 10-year follow-up (median, 51.9%; IQR, 49.6%-54.5%; P = .15). Left ventricular ejection fraction decreased (median, 59.6%; IQR, 55.6%-64.5% to median, 57.6%; IQR, 54.1%-61.6%; P < .001), whereas lateral E/e′ ratio, as an index of left ventricular filling pressure, increased (median, 5.1; IQR, 4.3-6.1 to median, 5.4; IQR, 4.5-6.4; P < .001) at the 10-year follow-up. No association of exercise-induced troponin T increase after the marathon with right and left ventricular ejection fraction changes at the 10-year follow-up was detected (Pearson r = −0.10, P = .35 and Pearson r = −0.09, P = .35, respectively). Conclusions and Relevance Results showed that marathon-induced acute troponin T increase was not associated with right ventricular ejection fraction after 10 years of endurance training and competition. Left ventricular ejection fraction and left ventricular diastolic function changed significantly; however, the values remained within normal limits. These data suggest that repetitive strenuous exercise training and endurance competitions did not induce long-term deterioration of right ventricular function in most recreational male endurance athletes.