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Background: Previous studies have suggested that marathon may induce reversible cardiac dysfunction. However, no previous study has assessed cardiac function during ultra distance and trail running. The aim of this study was to assess systolic and diastolic function during ultra distance and trail running.Methods: We studied 65 subjects participating in the 2010 and 2011 Ecotrail (80 kilometers). The population was divided in 37 subjects who underwent 2 echocardiographic examinations (before and at the end of the race) and 28 subjects who underwent several echocardiographic examinations: before, during the race (Km 21 and Km 50) and at the end of the race. We systematically recorded 2D parasternal long axis and apical 4, 3 and 2 chamber views, allowing to measure conventional LV parameters and longitudinal strain. We also recorded PW mitral inflow and Doppler tissue imaging of the mitral annulus (lateral and septal). All measurements were anonymously performed.Results: Left ventricular ejection fraction was significantly depressed at the end of the trail (64 ± 4% versus 70 ± 4% before, p < 0.0001), but not at Km 21 and 50. At Km 50, 2D longitudinal strain was significantly reduced as compared to longitudinal strain observed at baseline (- 19.4 ± 3% versus - 22.1 ± 2.1% before, p = 0.0008). Significant changes in transmitral velocities were observed after 21 Km, earlier than the abnormalities observed for the systolic function (E/A ratio: 1.6 ± 0.7 before versus 1 ± 0.4 at Km 21, p = 0.0004). These diastolic and systolic left ventricular dysfunctions were observed whatever the ranking of the runners.Conclusion: Our study suggests that ultra distance and trail running leads to abnormalities of systolic and diastolic function. Diastolic dysfunction arises earlier than systolic dysfunction. The assessment of longitudinal strain allows to earlier detect systolic dysfunction.