Acute trop T elevation not tied to reduced RV Function in Recreational Endurance Athletes: JAMA

A new study published in the Journal of American Medical Association showed that reduced right ventricular ejection fraction was not associated with acute troponin T increases due to marathons.

As endurance sports gain popularity, long-term changes in heart function among recreational marathon runners are becoming more widely acknowledged as a crucial topic of research. The ventricles, especially the right ventricle, may be temporarily strained by repeated exposure to prolonged, intense activity, raising concerns about possible long-term cumulative consequences. It is possible to determine whether these transient changes result in long-term myocardial abnormalities by examining how ventricular systolic and diastolic function varies over time.

To identify those who are at risk for maladaptive remodeling, guide safe training approaches, and reassure runners about the long-term cardiovascular effects of endurance involvement, it is crucial to comprehend these patterns. Therefore, after ten years of frequent, intense exercise sessions, this study was carried out to examine the rise in troponin T caused by marathons and its relationship to right ventricular remodeling.

The Prospective Follow-Up, Marathon, Long-Term, Inflammation, Cardiovascular System [Pro-MagIC] research was a long-term, observational cohort study that ran from August to December of 2019. Male marathon runners were chosen from a single German center to participate. This study's primary criteria were 10 years of endurance competitions and repeated, intense exercise training. 3-dimensional echocardiography and cardiac biomarkers were evaluated prior to the race, right after, on days one and three after the race, and at the 10-year follow-up.

Right ventricular ejection fraction (RVEF) decreased immediately after a marathon and one day after the race in 152 male runners (mean age 43 years), but it recovered to baseline 3 days later and stayed normal even 10 years later. At the 10-year follow-up, the lateral E/e′ ratio revealed somewhat greater filling pressures, but the left ventricular ejection fraction showed a modest drop. Crucially, neither long-term alterations in RVEF nor LVEF were associated with post-marathon troponin T increases.

Overall, the findings of this cohort study demonstrated that in endurance athletes, elevated TnT levels and a brief drop in RVEF immediately following a marathon run were not predictive markers of long-term RV dysfunction. However, during the 10-year follow-up, LVEF was considerably reduced and LV diastolic function was compromised, but values were still within normal ranges. Therefore,these results imply that the great majority of recreational male endurance athletes do not have long-term declines in RV function as a result of frequent, intense exercise training and endurance contests.

Reference:

Schindler, M. J., Schoenfeld, J., Trommler, A., Haller, B., Nieman, D. C., Halle, M., & Scherr, J. (2025). Long-term changes in ventricular function in recreational marathon runners. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2025.4456