title: The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography.
abstract: OBJECTIVE
  There is contradictory evidence related to the impact of ultra-marathon running on right ventricular (RV) structure and function. Consequently, the aims of this study were to: (1) comprehensively assess RV structure and function before and immediately following a 100-mile ultra-marathon in highly trained runners, (2) determine the nature of RV recovery 6 h post-race, and (3) document 12-lead electrocardiogram (ECG) changes post-exercise.
  
  
  METHODS
  Echocardiography and 12-lead ECG were assessed in 15 competitors in a repeated measures design before and immediately after completion of the 2013 Western States Endurance Race. A subset of nine was reassessed 6 h into recovery. Standard echocardiography was used to determine RV size, function and wall stress. Myocardial speckle tracking (MST) provided peak, time to peak and temporal indices for RV longitudinal strain and strain rates (ε and SR).
  
  
  RESULTS
  RV size was increased post-race (inflow tract 14 %, outflow tract 11 %, P = 0.004 and 0.002). RV wall stress was elevated by 11 % post-race. Peak RV ε was reduced by 10 % (P = 0.007) and significantly delayed post-race (P = 0.008). Most changes in RV function persisted at the 6-h assessment. Post-race there was an increase in the prevalence of right-sided ECG changes.
  
  
  CONCLUSIONS
  Completion of a 100-mile ultra-marathon resulted in acute changes in RV structure and function that persisted 6 h into recovery and are consistent with sustained exposure to an elevated RV wall stress. These findings were supported by right-sided changes to the 12-lead ECG.
authors.affiliation: Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK, r.lord@2009.ljmu.ac.uk.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lord
authors.forename: John
authors.initials: J
authors.lastname: Somauroo
authors.forename: Mike
authors.initials: M
authors.lastname: Stembridge
authors.forename: Nikhil
authors.initials: N
authors.lastname: Jain
authors.forename: Martin D
authors.initials: MD
authors.lastname: Hoffman
authors.forename: Keith
authors.initials: K
authors.lastname: George
authors.forename: Helen
authors.initials: H
authors.lastname: Jones
authors.forename: Rob
authors.initials: R
authors.lastname: Shave
authors.forename: Francois
authors.initials: F
authors.lastname: Haddad
authors.forename: Euan
authors.initials: E
authors.lastname: Ashley
authors.forename: David
authors.initials: D
authors.lastname: Oxborough
mesh_terms: D000328:Adult; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012420:Running; D016278:Ventricular Function, Right