Interstitial lung edema in endurance athletes: an ultrasound study

Purpose: The aim of this study was to investigate whether the interstitial lung edema is present in different endurance activities at sea level performed by amateur and elite athletes. Methods: We enrolled 71 endurance athletes (age 42.8 ±7.6 yrs, 59 males) studied after different competitions: 17 Ironman (IR), 13 Half-Iroman (HIR), 27 marathon runners (M), 14 100-Km elite runners (100Km). All the subjects underwent pulse oxymetry (02 Sat), echocardiography (left ventricular LV systolic and diastolic function, right ventricular (RV) function, systolic pulmonary pressure (sPAP), cardiac output (CO) and lung ultrasound (B Lines), before and immediately after race (within 15 min). Total Body Water (TBW), sodium (Na) and osmolality (Osm) were evaluated in IR, HIR and 100Km. Results: The mean duration of the competition was for IR 12.5 ± hrs, HIR 6± 0.6 hrs, M 4.9 ± 1,2 hrs, 100Km 8± 1 hrs. 02 Sat decreased after the race (rest 98±1 vs post 96±2 %, p<0.0001). LV systolic and diastolic function were normal and unchanged. Post-exercise sPAP was similar to the rest (post: 17±3 mmHg), whereas CO was higher (rest 4.1±1.6 vs post 5.4±1.5 l/min, p<0.0001). B lines increased significantly immediately after the race (rest 1,8(0-3) vs peak 15,4(5-19), p<0.0001) in all groups of athletes (see figure). TBW was unchanged (rest 45.9±7 vs post 44.5±6 Kg). Na and Osm were higher after competition (Na rest: 140±2, peak 142±5 mEq/l, p=0.03; rest Osm 298±4 vs post 307±10 mEq/l, p<0.0001). B Lines correlated with the CO post race (r=0,3, p=0.02) and with E/e' (r=0.3, p=0.02). Conclusions: Interstitial lung edema after exercise was present and related to the increase of CO and the diastolic function, but not related to grade of training, exercise duration, 02 Sat and hydration status.1