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Cardiovascular Events with Distance Running

Gerardin et al report on the Paris RACE registry. The authors quantify and determine correlates of case fatality with long distance running events. The authors also present a meta-analysis. Acute myocardial ischemia was the major underlying aetiology identified. However, non-shockable rhythm and non-ischemic heart disease were predictors of case fatality.

Abstract

Aim

Long distance running races are associated with a low risk of life-threatening events much often attributed to hypertrophic  cardiomyopathy. However, retrospective analyses of aetiology lack consistency.

Methods and results

Incidence and aetiology of life-threatening/fatal events were assessed in long distance races in the prospective Registre  des Accidents Cardiaques lors des courses d’Endurance (RACE Paris Registry) from October 2006 to September 2012.
Characteristics of life-threatening/fatal events were analysed by interviewing survivors and reviewing medical records including post-mortem data of each case. Seventeen life-threatening events were identified of 511 880 runners of which two were fatal. The vast majority were cardiovascular events (13/17) occurring in experienced male runners [mean
(+SD) age 43+10 years], with infrequent cardiovascular risk factors, atypical warning symptoms prior to the race or negative treadmill test when performed. Acute myocardial ischaemia was the predominant aetiology (8 of 13) and led to immediate myocardial revascularization. All cases with initial shockable rhythm survived. There was no
difference in event rate according to marathons vs. half-marathons and events were clustered at the end of the race. A meta-analysis of all available studies including the RACE Paris registry (n ¼ 6) demonstrated a low prevalence of life threatening
events (0.75/100 000) and that presentation with non-shockable rhythm [OR ¼ 29.9; 95% CI (4.0–222.5), P ¼ 0.001] or non-ischaemic aetiology [OR ¼ 6.4; 95% CI (1.4–28.8), P ¼ 0.015] were associated with case-fatality.

Conclusion

Life-threatening/fatal events during long distance races are rare, most often unpredictable and mainly due to acute myocardial ischaemia. Presentation with non-shockable rhythm and non-ischaemic aetiology are the major determinant of case fatality.

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