PURPOSES: To comprehensively investigate the cardiovascular consequences of a 
160-km ultramarathon using traditional echocardiography, speckle tracking 
imaging, cardiac biomarkers, and heart rate variability (HRV) and to examine the 
relationship between the changes in these variables.
METHODS: We examined athletes before an ultramarathon and reassessed all 
finishers immediately after the race. Left ventricular (LV) systolic (ejection 
fraction [EF], systolic blood pressure/end-systolic volume [SBP/ESV] ratio) and 
diastolic (ratio of early [E] to late [A], filling E:A) measurements were 
assessed using traditional echocardiography, whereas myocardial peak strain and 
strain rate were analyzed using speckle tracking. Cardiac biomarkers measured 
were cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide 
(NT-pro-BNP). HRV indices were assessed using standard frequency and time domain 
measures.
RESULTS: Twenty-five athletes successfully completed the race (25.5 +/- 3.2 h). 
Significant pre- to postrace changes in EF (66.8 +/- 3.8 to 61.2 +/- 4.0 %, P < 
0.05) and E:A ratio (1.62 +/- 0.37 to 1.35 +/- 0.33, P < 0.05) were reported. 
Peak strain was significantly decreased in all planes, with the largest 
reduction occurring circumferentially. NT-pro-BNP concentrations increased 
significantly (28 +/- 17.1 vs 795 +/- 823 ng x L, P < 0.05), whereas postrace 
cTnT were elevated in just five athletes (20%). No significant alterations in 
HRV were noted postrace. Reductions in LV function were not significantly 
associated with changes in cardiac biomarkers and/or HRV.
CONCLUSIONS: Although the stress of an ultramarathon resulted in a mild 
reduction in LV function and biomarker release, the mechanisms behind such 
consequences remain unknown. It is likely that factors other than myocardial 
damage or strong vagal reactivation contributed to postexercise decreases in LV 
function after an ultramarathon.