The aim of this study was to examine cardiac dysfunction following 
ultra-endurance exercise in male athletes. Fourteen athletes (mean+/-SD, age 
39+/-8 years) were evaluated before and after the European Championship in 
Triathlon 2003 using echocardiogram (ECG), cardiac markers [cardiac troponin T 
(cTnT) and pro-brain natriuretic peptide (pro-BNP)] and echocardiography. 
Conventional echocardiography techniques and new Doppler tissue imaging (DTI) 
modalities were applied before and immediately after the competition. Blood 
samples were drawn 1 week before, immediately after and 12-24 h 
post-competition. CTnT significantly increased immediately, but decreased to 
within normal limits 12-24 h post-competition. Pro-BNP was significantly 
increased immediately post-race (27+/-21 vs 7+/-2 pmol/L pre-race, P < or = 
0.007), which 12-24 h later, decreased to 19+/-14 pmol/L (P = 0.07 vs pre-race). 
During echocardiography, no significant differences were found in regional or 
global systolic parameters. Early diastolic peak flow velocity (9+/-2, P = 0.04) 
and E/A ratio (2+/-1, P = 0.004) were increased pre-race and decreased 
significantly toward normal values. In one athlete, cTnT levels increased 
significantly and systolic velocities decreased, thus suggesting reversible 
cardiac fatigue. When using cardiac markers and echocardiographic findings, a 
triathlon was found to have no significant negative effects on left ventricular 
function or myocardial tissue in male athletes.