What does this research mean for the field?

Marathon running induces transient cardiac remodeling that is more pronounced in male than female amateur athletes, with Galectin-3 serving as the most effective biomarker to reflect these myocardial overload changes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 4, 2025Frontiers in PhysiologyOpen Access

Morphological, functional and biochemical differences in cardiac adaptation to endurance exercise among male and female amateur marathon runners

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Why the study?

High-intensity activities such as marathon running may adversely affect cardiac morphology and function, and males and females exhibit discrepancies in cardiac response to training.

Does marathon running induce sex-specific morphological, functional, and biochemical cardiac alterations in amateur athletes?

Structured PICO

Does marathon running induce sex-specific morphological, functional, and biochemical cardiac alterations in amateur athletes?

Population

61 healthy Caucasian amateur marathon runners (34 male, 27 female), mean age 39 (males) and 40 (females), in sinus rhythm, without cardiovascular comorbidities.

Intervention

Marathon running (endurance exercise)

Comparator

Baseline measurements (2-3 weeks prior to marathon) and detraining measurements (2 weeks post-marathon), as well as cross-sex comparison (males vs. females)

Outcome

Exercise-induced myocardial alterations assessed by 3D echocardiographic parameters (ventricular volumes, ejection fraction) and cardiac biomarkers (CK, hs-TnI, H-FABP, BNP, Gal-3, ET-1, IL-6, neopterin) measured immediately after the marathon runsurrogate

Marathon running induces transient, sex-specific right ventricular dilation and biomarker elevation, which are more pronounced in male amateur athletes and correlate with lower baseline fitness.

Implication

May support pre-marathon fitness assessment in male amateurs; leaves open links to long-term outcomes.

Abstract

Introduction: 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. Methods: 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. Results: max values after the race showed higher levels of Gal-3 post-run (r = -0.29; p < 0.05). Conclusion: 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.