Cardiovascular Consequences in Intense and Extended Physical Exercise
Condition: Ventricular Arrythmia; Right Ventricular Dysfunction
MeSH terms: Ventricular Dysfunction; Ventricular Dysfunction, Right
Study type: Interventional

Summary: 
      This research study because you participate in long distance triathlon of Embrun. In recent
      years, there has been a craze for races at increasingly longer distances (ultra-endurance)
      with risks to the cardiovascular system poorly identified. In the short term, cardiac
      functional ultrasonographic changes and disturbances of biomarkers such as troponin are
      reported in participants in long-term endurance trials, assuming myocardial remodeling and
      transient tissue damage leading to suffering or "heart fatigue". These constraints could, to
      the extreme, favor the development of arrhythmia at the atrial and ventricular stages.
      Cardiac alterations are nevertheless poorly characterized and the consequences, in particular
      the risk of ventricular rhythm disturbance, have not been studied.The aim of this study is to
      investigate the relationship between right ventricular functional abnormalities and the
      occurrence of ventricular rhythm disturbance, following intense and prolonged exercise, in
      healthy triathletes subjects.
    

Detailed description: 
      Background and rationale:

      While regular and moderate physical activity is strongly recommended in reducing
      cardiovascular risk, the scientific community questions the potentially harmful effects of
      prolonged and intense physical activity. In the short term, functional ultrasonographic
      changes (systolic and diastolic) and disturbances of biomarkers such as troponin are reported
      in participants in long-term endurance trials, assuming myocardial remodeling and transient
      tissue damage leading to suffering or "heart fatigue". These constraints could, to the
      extreme, favor the development of arrhythmogenic foci at the atrial and ventricular stages,
      and at least, be responsible for a sudden death of the athlete. Adaptations of the athlete's
      heart have mainly been studied in the left ventricle but more and more studies are studying
      the right ventricle (RV). These alterations are nevertheless poorly characterized and the
      consequences including the risk of ventricular rhythm disorder have not been studied.

      Primary and Secondary Objectives:

      The primary objective is to test the existence of a relationship between RV functional
      abnormalities induced by intense and prolonged exercise, and the occurrence of ventricular
      ectopic beats (VEB) from RV. The secondary objectives are to characterize the respiratory
      impairment of this type of course and to study its relation with the functional anomalies of
      the RV and the occurrence of VEB.

      Methodology:

      This is a prospective study including male triathletes participating in the long-distance
      triathlon of Embrun in August 2019 (3.8 km of swimming, 188 km of cycling and 42.2 km of
      running), aged between 20 to 54 years years old. The criteria for non-inclusion are subjects
      with a history of heart disease or rhythm disorder or who have one or more cardiovascular
      risk factors, taking cardiovascular treatment or using doping products. The primary endpoint
      is the degree of correlation between course induced right ventricular functional
      abnormalities (by the use of 2d-strain ultrasound imaging) and the number of VEB from RV
      during or up to 72 hours after the race.

      Procedure:

      The study will take place during the Embrun triathlon in August 2019. There will be 2
      evaluations: one before the race and one 30 minutes after the race, where will be carried out
      a self-questionnaire, a clinical examination, EKG, echocardiography and spirometry. An EKG
      holter in the form of a patch, adapted to sport and submersible practice, will be put in
      place 24 to 48 hours before the race and left until 72 hours after the race.

      Outcomes / perspectives:

      Characterizing the effects of a long-distance triathlon on cardiac contractile function and
      evaluating the athlete's rhythmic risk would make it possible to better understand these
      pathophysiological consequences and ultimately better detect athletes at risk of sudden
      death.
    

Intervention name(s): EmbrunMan race
Intervention type(s): Other
Intervention description(s): The EmbrunMan is a long-duration triathlon including 3.8 km of swimming, 188 km of cycling and 42.2 km of running, with a cumulative vertical drop of 4000 metres. Duration of the race varies between 10 hours and 16hours depending on the athletes' performance.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic