Justin E. Trivax

Acute cardiac effects of marathon running

We sought to clarify the significance of cardiac dysfunction and to assess its relationship with elevated biomarkers by using cardiovascular magnetic resonance imaging in healthy, middle-aged subjects immediately after they ran 26.2 miles. Cardiac dysfunction and elevated blood markers of myocardial injury have been reported after prolonged strenuous exercise. From 425 volunteers, 13 women and 12 men were randomly selected, provided medical and training history, and underwent baseline cardiopulmonary exercise testing to exhaustion. Blood biomarkers, cardiovascular magnetic resonance imaging, and 24-h ambulatory electrocardiography were performed 4 wk before and immediately after the race. Participants were 38.7+/-9.0 yr old, had baseline peak oxygen consumption of 52.9+/-5.6 ml.kg(-1).min(-1), and completed the marathon in 256.2+/-43.5 min. Cardiac troponin I and B-type natriuretic peptide increased following the race (P=0.001 and P<0.0001, respectively). Cardiovascular magnetic resonance-determined pre- and postmarathon left ventricular ejection fractions were comparable, 57.7+/-4.1% and 58.7+/-4.3%, respectively (P=0.32). Right atrial volume index increased from 46.7+/-14.4 to 57.0+/-14.5 ml/m2 (P<0.0001). Similarly, right ventricular end-systolic volume index increased from 47.4+/-11.2 to 57.0+/-14.6 ml/m2 (P<0.0001) whereas the right ventricular ejection fraction dropped from 53.6+/-7.1 to 45.5+/-8.5% (P<0.0001). There were no morphological changes observed in the left atrium or ventricle or evidence of ischemic injury to any chamber by late gadolinium enhancement. There were no significant arrhythmias. Marathon running causes dilation of the right atrium and right ventricle, reduction of right ventricular ejection fraction, and release of cardiac troponin I and B-type natriuretic peptide but does not appear to result in ischemic injury to any chamber.

Changes in renal markers and acute kidney injury after marathon running

Background:  The impact of marathon running on kidney function has not been previously described.

Phidippides Cardiomyopathy: A Review and Case Illustration

Phidippides was a Greek messenger who experienced sudden death after running more than 175 miles in two days. In todays world, marathon running and other endurance sports are becoming more popular and raising concern about sudden deaths at these events. Once etiologies such has hypertrophic cardiomyopathy, anomalous coronary arteries, and coronary atherosclerosis have been excluded, there is now an additional consideration termed Phidippides cardiomyopathy. Because endurance sports call for a sustained increase in cardiac output for several hours, the heart is put into a state of volume overload. It has been shown that approximately one‐third of marathon runners experience dilation of the right atrium and ventricle, have elevations of cardiac troponin and natriuretic peptides, and in a smaller fraction later develop small patches of cardiac fibrosis that are the likely substrate for ventricular tachyarrhythmias and sudden death. Cardiac magnetic resonance imaging is emerging as the diagnostic test of choice for this condition. This review and case report summarizes the key features of this newly appreciated disorder.

Serum Cystatin C, Renal Filtration Function, and Left Ventricular Remodeling

It is estimated that heart failure (HF) affects 5.7 million Americans and will have an estimated cost of

New insights in preventive cardiology and cardiac rehabilitation.

34.8 billion in 2009.1 However, definitions of HF are mainly symptom based and, therefore, may lead to a gross underestimation of the actual prevalence. One study has shown that only 50% of people with echocardiographic evidence of left ventricular (LV) dysfunction are symptomatic.2 Article see p 98 It is now accepted that there is a link between renal dysfunction and heart disease, although physiological mechanisms remain unclear. The incidence and prevalence of chronic kidney disease are increasing, and it is estimated that 26 million Americans now have chronic kidney disease.1 From a public health standpoint, HF and chronic kidney disease are similar in that the underlying pathology is underway long before symptoms are manifested, thereby causing them to be largely underdiagnosed in their early stages. Any advance or improvement in early detection of HF or chronic kidney disease could have enormous potential to reduce the morbidity and mortality from these treatable diseases. The Dallas Heart Study showed that serum levels of cystatin C were independently associated with LV mass, concentricity, and wall thickness as measured by MRI.3 Male gender, hypertension, and use of antihypertensive medications were all associated with elevations of cystatin C. However, even after adjustment for these and other traditional risk factors, including estimated glomerular filtration rate (eGFR), the associations of cystatin C with a pathological cardiac phenotype persisted. These findings show that the risk of HF predicted by elevations of cystatin C is more than can be explained by its surrogacy as a predictor of impaired renal function. Clinical inferences concerning renal filtration function have been fundamental to medical evaluation of patients for over half a century. Serum creatinine has been the laboratory mainstay measure, …

SELDI-TOF-MS Serum Profiling Reveals Predictors of Cardiac MRI Changes in Marathon Runners.

Purpose of review To summarize changing paradigms and perceptions in the prevention and treatment of cardiovascular disease. Recent findings Recent studies have shown that arterial inflammation probably plays a key role in the development and progression of atherosclerosis, that acute myocardial infarctions often evolve from mild-to-moderate coronary artery stenoses, that patients who experience a fatal coronary event invariably had antecedent exposure to one or more major coronary risk factors, that angiographic findings may vastly underestimate underlying atherosclerotic coronary artery disease, and that many elective coronary revascularization procedures may be unnecessary. Moreover, cardiorespiratory fitness appears to be one of the strongest prognostic markers in persons with and without heart disease. Summary Collectively, these data highlight the value of comprehensive risk factor modification in the prevention of initial and recurrent cardiovascular events.

Cardiorespiratory Fitness and Short-term Complications After Bariatric Surgery

Purpose. To utilize proteomics to discover proteins associated with significant cardiac magnetic resonance imaging (MRI) changes in marathon runners. Methods. Serum from 25 runners was analyzed by surface enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Proteomic profiles were compared in serum samples obtained prior to the race, at the finish line and within 7 hours after race to identify dynamic proteins correlated with cardiac MRI changes. Results. 693 protein/peptide clusters were identified using two ProteinChip surface chemistries and, of these, 116 were significantly different between the three time points. We identified 7 different patterns of protein expression change within the runners and 5 prerace protein peaks, 16 finish-line protein levels, and 15 postrace proteins which were correlated with significant postrace cardiac MRI changes. Conclusions. This study has identified baseline levels of proteins which may be predictive of risk of significant cardiac damage following a marathon race. Preliminary identification of the significant proteins suggested the involvement of cytokines and other proteins involved in stress and inflammatory response.