What is the clinical evidence from this study?

Study design: Cohort. Population: Healthy recreational endurance athletes (n=109). Intervention: Marathon race. Primary outcome: Abnormal ECG findings during the marathon.

What does this research mean for the field?

During a marathon, approximately one in six recreational endurance athletes experience abnormal ECG findings, and exercise-induced transient ST-T-segment deviations are strongly associated with elevated high-sensitive troponin T levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 1, 2017Open Access

Frequency of exercise-induced ST-T-segment deviations and cardiac arrhythmias in recreational endurance athletes during a marathon race: results of the prospective observational Berlin Beat of Running study

JHJuliane HermHumboldt-Universität zu Berlin ATAgnieszka TöpperMax Delbrück Center AWAlexander WutzlerKlinikum Frankfurt Höchst

Key Result

Continuous ECG monitoring during a marathon race revealed abnormal findings in 16.8% of recreational athletes, including non-sustained ventricular tachycardia and ST-T-segment deviations.

Study Design

Type

Cohort (n=109)

Blinding

Blinded outcome assessment

Multicenter

Structured PICO

What is the frequency of exercise-induced ST-T-segment deviations and cardiac arrhythmias in recreational endurance athletes during a marathon race?

Population

109 healthy, experienced recreational marathon runners (median age 48, 24% women) who underwent continuous ECG monitoring during a marathon race.

Exposure

Continuous portable ECG monitoring during a marathon race and blood tests 2-3 days prior, directly after, and 1-2 days after the race.

Outcome

Frequency of cardiac arrhythmias (especially atrial fibrillation) and ST-T-segment deviations during a marathon race.surrogate

Continuous ECG monitoring during a marathon revealed abnormal findings in 16.8% of recreational athletes, with transient ST-T-segment deviations strongly associated with post-race hsTnT elevation.

Abstract

OBJECTIVES: While regular physical exercise has many health benefits, strenuous physical exercise may have a negative impact on cardiac function. The 'Berlin Beat of Running' study focused on feasibility and diagnostic value of continuous ECG monitoring in recreational endurance athletes during a marathon race. We hypothesised that cardiac arrhythmias and especially atrial fibrillation are frequently found in a cohort of recreational endurance athletes. The main secondary hypothesis was that pathological laboratory findings in these athletes are (in part) associated with cardiac arrhythmias. DESIGN: Prospective observational cohort study including healthy volunteers. SETTING AND PARTICIPANTS: One hundred and nine experienced marathon runners wore a portable ECG recorder during a marathon race in Berlin, Germany. Athletes underwent blood tests 2-3 days prior, directly after and 1-2 days after the race. RESULTS: Overall, 108 athletes (median 48 years (IQR 45-53), 24% women) completed the marathon in 249±43 min. Blinded ECG analysis revealed abnormal findings during the marathon in 18 (16.8%) athletes. Ten (9.3%) athletes had at least one episode of non-sustained ventricular tachycardia, one of whom had atrial fibrillation; eight (7.5%) individuals showed transient ST-T-segment deviations. Abnormal ECG findings were associated with advanced age (OR 1.11 per year, 95% CI 1.01 to 1.23), while sex and cardiovascular risk profile had no impact. Directly after the race, high-sensitive troponin T was elevated in 18 (16.7%) athletes and associated with ST-T-segment deviation (OR 9.9, 95% CI 1.9 to 51.5), while age, sex and cardiovascular risk profile had no impact. CONCLUSIONS: ECG monitoring during a marathon is feasible. Abnormal ECG findings were present in every sixth athlete. Exercise-induced transient ST-T-segment deviations were associated with elevated high-sensitive troponin T (hsTnT) values. TRIAL REGISTRATION: ClinicalTrials.gov NCT01428778; Results.

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