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Be well trained when running a marathon!

Comment by Erik Solberg, EACPR Sports Cardiology Section

Transient Myocardial Tissue and Function Changes During a Marathon in Less Fit Marathon Runners
V. Gaudreault et al.
Canadian Journal of Cardiology 2013; 29 (10) :1269-1276


This in-depth study of fairly typical recreational marathon runners (1) showed that global left ventricular and right ventricular ejection fraction decreased in half of the runners as a response to marathon. These runners had poorer peak training distance, poorer training time, as well as a lower fitness level. Overall, 36% of cardiac segments developed edema, 53% decreased function and 59% decreased perfusion.

Significant agreement was observed between segment decreasing function, decreasing perfusion and developing edema, suggesting myocardial tissue injury. Change in global left ventricular ejection fraction was associated with Vo2max. The myocardial changes were reversible at the scheduled three months post-race test.

Completing a marathon, in consequence, may lead to signs of myocardial injuries occurring more extensively in less trained and less fit runners. These changes may potentially contribute to the transient increase in cardiac risk, reported during sustained exercise and also explain the biomarker changes after marathon.

The findings may well represent “physiological” responses to longstanding exercise like marathon and does not allow categorical statement regarding possible long-term harm of marathon running. Studies, however, repeatedly show transient cardiac tissue injuries after marathon races. Although the clinical relevance is at present unclear, decreased perfusion (even transient) may potentially increase the risk of arrhythmias in runners with an underlying cardiovascular abnormality.

A lesson to learn is to be healthy, well prepared and well trained when running a marathon, as the cardiac injury is most pronounced in the less trained cohort.

(1) n=20; mean 52 years old, VO2max 53 ml*min-1*kg-1, exercising 8 hours per week, 62 km per week, running in 14 years, average marathon race time 232 min