Table 2 Study characteristics and outcomes of the clinical studies

Caillaud 1995

Pulmonary function

DL_CO, K_CO, V_A, Pulmonary Volume (CT), MLD

Pre- and post Olympic Triathlon

Water temperature 14 °C

No change in VC and TLC, DLCO and KCO reduced, slight increase in extrapulmonary water, significant increase in MLD

Choi 2004

Arrythmia Long QT syndrome

Genetic testing

LQTS +CPVT1 gene present in 90.7% swimming triggered events

Ludwig 2006

Pulmonary function

TLC, VC, FEV₁, FEV₁/FVC, DL_CO

Non randomized study, testing following cycle ergometry, SIPE subjects versus control group

No difference between groups

Wester 2009

Pulmonary function

VT, V_O2, VE, VD/VT, V_CO2, Ph, P_CO2, P_O2, MAP, MPAP, PAWP, CVP

Dry and immersion exercise in cold (19 °C) and warm (28 °C)

MPAP, CVP higher in cold water

Fraser 2010

Pulmonary function

VC, FEV₁, FEV_25–75, HCVR, VO_2max, PAP, MAP, MPAP, CVP

Cold water immersions (20-21 °C)

Hyper vs normoxia

Cold water immersion associated with higher mean PAP, PVR, MPAP favouring conditions for pulmonary oedema, PAWP approached threshold to pulmonary capillary leak pressures

Harris 2010

Deaths in Triathlons

Heart Morphology

Autopsy (n = 9)

7 left VH, 1 congenital coronary artery anomaly

Pingitore 2011

Echocardiography, Chest Ultrasound, Pulmonary function

VC, FEV1, Troponin, IL

LV systolic function and volume

Pre- and post Ironman event

Transient and interstitial pulmonary oedema in all athletes

Moon 2016

Deaths in Triathlons

Heart mass, ventricular thickness, coronary abnormalities

Autopsy (n = 23)

95% heart mass > than normal, 23 > 70% CAD narrowing, 32% > 50%CAD narrowing

Moon 2016

Pulmonary function

CVP, MAP, MPAP, PAWP

Submersion in 20 °C water

CVP 23% increase, PAWP 25% increase, MPAP 26% increase, MAP 7% increase

Shearer 2009

Brain natriuretic peptide (BNP)

BNP

BNP levels in 6 cases confirmed with SIPE in the ER

Within normal for all subjects