Marathon Paradox - William Beaumont Hospital
Marathon Paradox - William Beaumont Hospital
Marathon Paradox - William Beaumont Hospital
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Case Presentation<br />
Sparta<br />
75 miles<br />
75 miles<br />
<strong>Marathon</strong><br />
<strong>Paradox</strong>:<br />
Run Hard,<br />
Die Young?<br />
19 th Annual Cardiovascular Conference<br />
<strong>Marathon</strong><br />
26.2 miles<br />
Beaver Creek,Colorado<br />
Justin Trivax, Trivax,<br />
MD<br />
<strong>William</strong> <strong>Beaumont</strong> <strong>Hospital</strong><br />
Royal Oak, Michigan
Tragedy in Detroit<br />
Gaining Popularity<br />
• Participation in endurance sports has<br />
increased significantly worldwide.<br />
• In the US, over 468,000 participants completed<br />
at least one marathon in 2009.
Training<br />
5<br />
3<br />
9<br />
1<br />
2<br />
5<br />
Trivax, JE, McCullough P, Franklin B. Acute Cardiac Effects of <strong>Marathon</strong> Running. Circulation 2009;120: S513<br />
Training<br />
↑ LV Chamber Size<br />
↑ LV Chamber Thickness<br />
↑ LV Mass<br />
(Secondary to volume and<br />
pressure overload)<br />
Scharhag J et al. Athlete’s Athlete s heart JACC 2002; 40:1856-63.<br />
40:1856 63.
Training<br />
Training<br />
↑ LV Chamber Size<br />
↑ LV Chamber Thickness<br />
↑ LV Mass<br />
(Secondary to volume and<br />
pressure overload)<br />
↑ LV Chamber Size<br />
↑ LV Chamber Thickness<br />
↑ LV Mass<br />
(Secondary to volume and<br />
pressure overload)<br />
<strong>Marathon</strong><br />
<strong>Marathon</strong><br />
↑ Catecholamines,<br />
↑ O2 demand,<br />
↑ ↑ ↑ Preload, ↑ Afterload,<br />
Metabolic Abnormalities,<br />
Acute Kidney injury,<br />
Dehydration<br />
↑ Troponin, ↑ CK (CK-MB), (CK MB),<br />
↑ BNP<br />
1) Trivax, JE. Circ 2009;120: S513 2) Douglas, P et al. Circ 1987; 76: 1206. 3) Siegel AJ. Am J Cardiol 2001; 88: 920.
Training<br />
Scharhag J et al. Athlete’s Athlete s heart JACC 2002; 40:1856-63.<br />
40:1856 63.<br />
Trivax, JE et al. Circulation 2009;120: S513<br />
Training<br />
Restoration of RA and RV geometry<br />
Early inflammation and edema with<br />
desmosomal reconfiguration<br />
Trivax, JE et al. Circulation 2009;120: S513<br />
↑ LV Chamber Size<br />
↑ LV Chamber Thickness<br />
↑ LV Mass<br />
(Secondary to volume and<br />
pressure overload)<br />
↑ LV Chamber Size<br />
↑ LV Chamber Thickness<br />
↑ LV Mass<br />
(Secondary to volume and<br />
pressure overload)<br />
Subacute Effects<br />
<strong>Marathon</strong><br />
↑ Catecholamines,<br />
↑ O2 demand,<br />
↑ ↑ ↑ Preload, ↑ Afterload,<br />
Metabolic Abnormalities,<br />
Acute Kidney injury,<br />
Dehydration<br />
↑ Troponin, ↑ CK (CK-MB), (CK MB),<br />
↑ BNP<br />
Immediate Effects<br />
Marked right heart strain<br />
RA and RV dilation<br />
RV hypokinesis<br />
Diastolic dysfunction<br />
Cardiac desmosomal dysfunction<br />
<strong>Marathon</strong><br />
↑ Catecholamines,<br />
↑ O2 demand,<br />
↑ ↑ ↑ Preload, ↑ Afterload,<br />
Metabolic Abnormalities,<br />
Acute Kidney injury,<br />
Dehydration<br />
↑ Troponin, ↑ CK (CK-MB), (CK MB),<br />
↑ BNP<br />
Immediate Effects<br />
Marked right heart strain<br />
RA and RV dilation<br />
RV hypokinesis<br />
Diastolic dysfunction<br />
Cardiac desmosomal dysfunction
Training<br />
↑ Cardiac chamber size<br />
↑ Atrial arrhythmias<br />
↑ Ventricular arrhythmias<br />
↑ Incidence of SCD<br />
Patchy areas of fibrosis<br />
Long-term Effects<br />
75<br />
70<br />
65<br />
60<br />
55<br />
50<br />
45<br />
40<br />
Restoration of RA and RV geometry<br />
Early inflammation and edema with<br />
desmosomal reconfiguration<br />
Ector Molina Ector Molina et et al. al. European Europace Heart 2008; Journal 10, 618-623. 61810;<br />
10; 623. 1093 Dec 2006.<br />
↑ LV Chamber Size<br />
↑ LV Chamber Thickness<br />
↑ LV Mass<br />
(Secondary to volume and<br />
pressure overload)<br />
p
Patchy Fibrosis<br />
Patchy Fibrosis<br />
Breuckmann et al. Radiology 251 (1) 2009.<br />
Breuckmann et al. Radiology 251 (1) 2009.
Patchy Fibrosis<br />
↑ Cardiac chamber size<br />
↑ Atrial arrhythmias<br />
Training<br />
↑ Ventricular arrhythmias<br />
↑ Incidence of SCD<br />
Patchy areas of fibrosis<br />
Long-term Effects<br />
Restoration of RA and RV geometry<br />
Early inflammation and edema with<br />
desmosomal reconfiguration<br />
↑ LV Chamber Size<br />
↑ LV Chamber Thickness<br />
↑ LV Mass<br />
(Secondary to volume and<br />
pressure overload)<br />
Subacute Effects<br />
Breuckmann et al. Radiology 251 (1) 2009.<br />
<strong>Marathon</strong><br />
Phidippides<br />
Cardiomyopathy<br />
↑ Catecholamines,<br />
↑ O2 demand,<br />
↑ ↑ ↑ Preload, ↑ Afterload,<br />
Metabolic Abnormalities,<br />
Acute Kidney injury,<br />
Dehydration<br />
↑ Troponin, ↑ CK (CK-MB), (CK MB),<br />
↑ BNP<br />
Immediate Effects<br />
Marked right heart strain<br />
RA and RV dilation<br />
RV hypokinesis<br />
Diastolic dysfunction<br />
Cardiac desmosomal dysfunction
Conclusions<br />
• Phidippides Cardiomyopathy (PC), also referred to as<br />
Runner’s Runner s Cardiomyopathy, is a novel term and newly<br />
recognized disorder that has been affecting runners and<br />
endurance athletes for thousands of years.<br />
• PC may never cause symptoms or may present in some<br />
as sudden cardiac death resulting from ventricular<br />
arrhythmias.<br />
• Cardiac MRI with LGE is the only imaging modality that<br />
can accurately diagnose PC and is the test of choice to<br />
risk stratify endurance athletes.<br />
• Those who are most likely to suffer from PC may have a<br />
genetic predisposition; though, more research is needed<br />
to further delineate this syndrome.
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