Lasocka-Koriat Zofia, Lewicka-Potocka Zuzanna, Kaleta-Duss Anna, Bulman Nikola, Marciniak Ewelina, Kalinowski Leszek, Lewicka Ewa, Dąbrowska-Kugacka Alicja
Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland.
First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland.
Front Physiol. 2025 Mar 4;16:1547894. doi: 10.3389/fphys.2025.1547894. eCollection 2025.
Sport is known to have beneficial influence on cardiovascular system. However, activities of high intensity such as marathon running may adversely affect cardiac morphology and function, especially in the heterogenous group of amateur athletes. As males and females exhibit discrepancies in cardiac response to training, we aimed to compare exercise-induced myocardial alterations between sexes among 61 amateur marathon runners, with the use of evolving echocardiographic techniques and cardiac biomarkers.
The study followed three stages: 2-3 weeks prior the marathon (Stage 1), at the finish line (Stage 2) and 2 weeks after the run (Stage 3). Echocardiographic examination along with blood analyses for biomarkers of cardiac injury and overload [creatine kinase, high sensitivity cardiac troponin I, heart-type fatty acid binding protein, B-type natriuretic peptide, galectin-3 (Gal-3), endothelin-1 (ET-1), interleukin-6 and neopterin] were performed at each stage.
After the marathon there was a transient increase in right ventricular (RV) size and concomitant decrease in left ventricular (LV) volumes, leading to a significant increase of RV end-diastolic volume (RVEDV)/LVEDV ratio (0.91 ± 0.21 vs. 1.10 ± 0.22, p < 0.001 in males; 0.73 ± 0.17 vs. 1.02 ± 0.22, p < 0.001 in females). Although at Stage 2 RV contractility decreased, while LV ejection fraction (LVEF) remained at the same level in both sexes, men had greater tendency for LVEF reduction (p < 0.05 for the interaction sex and stage). The concentrations of biomarkers were higher after the run in both study groups, except for ET-1 and neopterin, which increased post-race only in males. The larger training-related rise in Gal-3 level correlated with the greater drop in LVEF at Stage 2 (r = -0.42; p < 0.05). Less-trained marathoners with lower VOmax values after the race showed higher levels of Gal-3 post-run (r = -0.29; p < 0.05).
Marathon running induces transient cardiac remodelling, more pronounced in male than female athletes. Structural and functional changes assessed by echocardiography correspond with biochemical alterations. Galectin-3 was the best biomarker to reflect overload changes. Cardiovascular screening in amateur runners should be implemented to identify subjects requiring further evaluation.
众所周知，运动对心血管系统有有益影响。然而，诸如马拉松跑步等高强度活动可能会对心脏形态和功能产生不利影响，尤其是在非专业运动员这一异质性群体中。由于男性和女性在心脏对训练的反应方面存在差异，我们旨在利用不断发展的超声心动图技术和心脏生物标志物，比较61名业余马拉松跑者中不同性别的运动诱发心肌改变情况。
该研究分为三个阶段：马拉松比赛前2 - 3周（阶段1）、终点线处（阶段2）以及赛后2周（阶段3）。在每个阶段都进行了超声心动图检查以及对心脏损伤和超负荷生物标志物[肌酸激酶、高敏心肌肌钙蛋白I、心型脂肪酸结合蛋白、B型利钠肽、半乳糖凝集素-3（Gal-3）、内皮素-1（ET-1）、白细胞介素-6和蝶呤]的血液分析。
马拉松赛后，右心室（RV）大小短暂增加，同时左心室（LV）容积减小，导致RV舒张末期容积（RVEDV）/LV舒张末期容积（LVEDV）比值显著增加（男性：0.91±0.21对1.10±0.22，p<0.001；女性：0.73±0.17对1.02±0.22，p<0.001）。尽管在阶段2时RV收缩力下降，而男女两性的左心室射血分数（LVEF）保持在同一水平，但男性LVEF降低的趋势更大（性别和阶段的交互作用p<0.05）。两个研究组在赛后生物标志物浓度均升高，但ET-1和蝶呤除外，这两种标志物仅在男性赛后升高。Gal-3水平与训练相关的更大升高与阶段2时LVEF的更大下降相关（r = -0.42；p<0.05）。赛后最大摄氧量（VOmax）值较低、训练较少的马拉松跑者赛后Gal-3水平较高（r = -0.29；p<0.05）。
马拉松跑步会诱发短暂的心脏重塑，在男性运动员中比女性更明显。通过超声心动图评估的结构和功能变化与生化改变相对应。半乳糖凝集素-3是反映超负荷变化的最佳生物标志物。应在业余跑步者中开展心血管筛查，以识别需要进一步评估的对象。
