title: Early subclinical increase in pulmonary water content in athletes performing sustained heavy exercise at sea level: ultrasound lung comet-tail evidence.
abstract: Whether prolonged strenuous exercise performed by athletes at sea level can produce interstitial pulmonary edema is under debate. Chest sonography allows to estimate extravascular lung water, creating ultrasound lung comet-tail (ULC) artifacts. The aim of the study was to determine whether pulmonary water content increases in Ironmen (n = 31) during race at sea level and its correlation with cardiopulmonary function and systemic proinflammatory and cardiac biohumoral markers. A multiple factor analysis approach was used to determine the relations between systemic modifications and ULCs by assessing correlations among variables and groups of variables showing significant pre-post changes. All athletes were asymptomatic for cough and dyspnea at rest and after the race. Immediately after the race, a score of more than five comet tail artifacts, the threshold for a significant detection, was present in 23 athletes (74%; 16.3 ± 11.2; P < 0.01 ULC after the race vs. rest) but decreased 12 h after the end of the race (13 athletes; 42%; 6.3 ± 8.0; P < 0.01 vs. soon after the race). Multiple factor analysis showed significant correlations between ULCs and cardiac-related variables and NH(2)-terminal pro-brain natriuretic peptide. Healthy athletes developed subclinical increase in pulmonary water content immediately after an Ironman race at sea level, as shown by the increased number of ULCs related to cardiac changes occurring during exercise. Hemodynamic changes are one of several potential factors contributing to the mechanisms of ULCs.
authors.affiliation: CNR Institute of Clinical Physiology, Scuola Superiore Sant'Anna, Pisa, Italy. pingi@ifc.cnr.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pingitore
authors.forename: Erika
authors.initials: E
authors.lastname: Garbella
authors.forename: Paolo
authors.initials: P
authors.lastname: Piaggi
authors.forename: Danilo
authors.initials: D
authors.lastname: Menicucci
authors.forename: Francesca
authors.initials: F
authors.lastname: Frassi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lionetti
authors.forename: Andrea
authors.initials: A
authors.lastname: Piarulli
authors.forename: Giosuè
authors.initials: G
authors.lastname: Catapano
authors.forename: Valter
authors.initials: V
authors.lastname: Lubrano
authors.forename: Mirko
authors.initials: M
authors.lastname: Passera
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.forename: Cinzia
authors.initials: C
authors.lastname: Castagnini
authors.forename: Silvia
authors.initials: S
authors.lastname: Pellegrini
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Metelli
authors.forename: Remo
authors.initials: R
authors.lastname: Bedini
authors.forename: Angelo
authors.initials: A
authors.lastname: Gemignani
authors.forename: Antonio
authors.initials: A
authors.lastname: L'Abbate
mesh_terms: D000328:Adult; D016477:Artifacts; D058070:Asymptomatic Diseases; D054874:Athletic Performance; D001642:Bicycling; D015415:Biomarkers / Q000097:blood; D015444:Exercise; D015633:Extravascular Lung Water / Q000378:metabolism*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008168:Lung / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D012119:Respiration; D012129:Respiratory Function Tests; D012420:Running; D013550:Swimming; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators