Hédon Christophe, Gouzi Fares, Padovani Caroline, Schuster Iris, Maufrais Claire, Cade Stéphane, Cransac Frédéric, Bui Gaspard, Morcillo Samuel, Ayoub Bronia, Thireau Jérôme, Izem Omar, Reboul Cyril, Walther Guillaume, Hayot Maurice, Nottin Stéphane, Cazorla Olivier
PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, 34295, Montpellier, France.
Cardiology Department, CHU Montpellier, Montpellier, France.
Sports Med. 2025 Mar;55(3):739-751. doi: 10.1007/s40279-024-02128-8. Epub 2024 Oct 16.
Prolonged strenuous exercise can transiently decrease cardiac function. Other studies have identified three major exercise-induced pulmonary changes: bronchoconstriction, dynamic hyperinflation and pulmonary oedema with reduced alveolar-capillary membrane diffusing capacity. This study investigated whether athletes with one of these pulmonary dysfunctions following a very long-distance triathlon exhibit similar cardiac alterations as those without dysfunctions.
Sixty trained male triathletes (age 39 ± 9 years) underwent baseline and post-race assessments, including echocardiography (with standard, 2D-strain and myocardial work assessments), spirometry and double-diffusion technique to evaluate alveolar-capillary membrane diffusing capacity for carbon monoxide (DM). Cardiac function in athletes with exercise-induced bronchoconstriction (> 10% decrease FEV), dynamic hyperinflation (> 10% decrease inspiratory capacity) or impaired diffusion capacity (> 20% decrease DM/alveolar volume) were compared with those without these dysfunctions.
The race lasted 14 h 20 min ± 1 h 26 min. Both systolic and diastolic cardiac functions declined post-race. Post-race, 18% of athletes had bronchoconstriction, 58% dynamic hyperinflation and 40% impaired diffusing capacity. Right and left ventricular standard and 2D-strain parameters were similar before the race in all subgroups and changed similarly post-race, except E/E', which decreased in the bronchoconstriction subgroup and increased in those with diffusion impairment. Global constructive work decreased by ~ 19% post-race (2302 ± 226 versus 1869 ± 328 mmHg%, P < 0.001), more pronounced in athletes with diffusion impairment compared with others (- 26 ± 13 versus - 15 ± 9%, P = 0.001) and positively correlated with DM/alveolar volume reduction.
After a very long-distance triathlon, bronchoconstriction and hyperinflation were not associated with significant cardiac changes, whereas impaired alveolar-capillary membrane diffusing capacity was associated with a more significant decline in myocardial function. These findings highlight the complex relationship between pulmonary gas exchange abnormalities and cardiac fatigue following prolonged strenuous exercise.
长时间剧烈运动可使心脏功能暂时下降。其他研究已确定运动引起的三种主要肺部变化：支气管收缩、动态肺过度充气和肺水肿伴肺泡-毛细血管膜弥散能力降低。本研究调查了在超长距离铁人三项赛后出现这些肺部功能障碍之一的运动员是否表现出与无功能障碍的运动员类似的心脏改变。
60名训练有素的男性铁人三项运动员（年龄39±9岁）接受了基线和赛后评估，包括超声心动图（采用标准、二维应变和心肌做功评估）、肺活量测定和双扩散技术以评估一氧化碳的肺泡-毛细血管膜弥散能力（DM）。将运动诱发支气管收缩（第一秒用力呼气量下降>10%）、动态肺过度充气（吸气量下降>10%）或弥散能力受损（DM/肺泡容积下降>20%）的运动员的心脏功能与无这些功能障碍的运动员进行比较。
比赛持续14小时20分钟±1小时26分钟。赛后心脏收缩和舒张功能均下降。赛后，18%的运动员出现支气管收缩，58%出现动态肺过度充气，40%出现弥散能力受损。所有亚组赛前右心室和左心室的标准参数及二维应变参数相似，赛后变化也相似，但E/E'除外，其在支气管收缩亚组中下降，在弥散功能受损亚组中升高。赛后整体建设性做功下降约19%（2302±226对1869±328mmHg%，P<0.001），与其他运动员相比，弥散功能受损的运动员下降更明显（-26±13对-15±9%，P=0.001），且与DM/肺泡容积降低呈正相关。
在超长距离铁人三项赛后，支气管收缩和肺过度充气与明显的心脏变化无关，而肺泡-毛细血管膜弥散能力受损与心肌功能更显著下降有关。这些发现突出了长时间剧烈运动后肺气体交换异常与心脏疲劳之间的复杂关系。
