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Acute effects of marathon running on the heart: a systematic review and meta-analysis
Inarota Laily1,2,3,4,5, Niels van Steijn1,5, Putra Rizki6
1Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Background:
Marathon running has numerous cardiovascular effects. Studies report transient physiological changes, while others identify possible harmful cardiovascular changes. This systematic review and meta-analysis aimed to characterise acute cardiac effects of marathon running.
Methods:
A systematic search was conducted in PubMed, Embase, and SPORTDiscus up to 11 April 2025. Studies were included if they reported (i) primary data (ii) in English (iii) healthy adults completing a road marathon, (iv) quantitative pre- and post-marathon cardiac effects. After data extraction (myocardial biomarkers, morphology, and function), random-effect meta-analyses were performed to determine mean differences and relative changes between pre- and post-marathon. Meta-regression analyses were performed in metrics with ≥7 studies.
Results:
Of 9080 articles, 69 were eligible for systematic review (3274 participants: age 30-55 years, >80% men) and 49 for meta-analysis on three biomarkers, 18 echocardiography metrics, and five cardiac MRI metrics. Marathon running-induced increases in circulating troponin T (+42 (32.6, 52.3) ng/L; p<0.001), troponin I (+77 (55.1, 98.3) ng/L; p<0.001) and N-terminal pro B-type natriuretic peptide (NT-proBNP) (+114 (89.0, 138.6) ng/L; p<0.001). On echocardiography, left ventricular (LV) volume and diastolic function, and right ventricular (RV) systolic function decreased post-marathon, while RV end-systolic and diastolic volumes increased. Cardiac MRI revealed an increase in LV ejection fraction. On meta-regression analysis, these responses varied according to age, sex, training status and marathon performance.
Conclusion:
Marathon running induces acute changes in biomarkers of myocardial injury, cardiac structure and function. The clinical significance and potential for harm of these changes are yet to be established.
Prospero Registration Number:
CRD42023399120.
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