{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:59:51Z","timestamp":1781053191429,"version":"3.54.1"},"reference-count":87,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Indonesia Endowment Fund for Education (LPDP","award":["201803220412678"],"award-info":[{"award-number":["201803220412678"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Sport Exerc Med"],"accepted":{"date-parts":[[2026,4,22]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u22657 studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 9080 articles, 69 were eligible for systematic review (3274 participants: age 30\u201355 years, &gt;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&lt;0.001), troponin I (+77 (55.1, 98.3) ng\/L; p&lt;0.001) and N-terminal pro B-type natriuretic peptide (NT-proBNP) (+114 (89.0, 138.6) ng\/L; p&lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023399120<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsem-2026-003201","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:20:13Z","timestamp":1781050813000},"page":"e003201","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute effects of marathon running on the heart: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3744-0099","authenticated-orcid":false,"given":"Inarota","family":"Laily","sequence":"first","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Center for Sport and Exercise Studies, Indonesian Medical Education and Research Institute, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia"},{"name":"Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands"},{"name":"Amsterdam Movement Sciences, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"van Steijn","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Movement Sciences, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Putra","family":"Rizki","sequence":"additional","affiliation":[{"name":"Sports Medicine Rehabilitation and Wellness Center, Hasan Sadikin Hospital, Bandung, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"de Vries","sequence":"additional","affiliation":[{"name":"Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lies D","family":"Liastuti","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aeilko H","family":"Zwinderman","sequence":"additional","affiliation":[{"name":"Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9227-8234","authenticated-orcid":false,"given":"Evert","family":"Verhagen","sequence":"additional","affiliation":[{"name":"Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"},{"name":"Medical & Anti-Doping, Union of European Football Associations (UEFA), Nyon, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9291-9441","authenticated-orcid":false,"given":"Adrianus J","family":"Bakermans","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3617-3256","authenticated-orcid":false,"given":"Harald T","family":"Jorstad","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands"},{"name":"Amsterdam Movement Sciences, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"2026060917200585000_12.2.e003201.1","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.tcm.2015.06.005","article-title":"The U-shaped relationship between exercise and cardiac morbidity","volume":"26","author":"Merghani","year":"2016","journal-title":"Trends Cardiovasc Med"},{"key":"2026060917200585000_12.2.e003201.2","unstructured":"Andersen JJ . 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