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Li H, Kang L, Sun Y. Clinical value of cardiac color ultrasound and cardiac troponin T combined with dynamic electrocardiogram in treatment of acute pulmonary embolism. Exp Ther Med 2018; 15:2044-2048. [PMID: 29434803 PMCID: PMC5776628 DOI: 10.3892/etm.2017.5658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/12/2017] [Indexed: 11/25/2022] Open
Abstract
The clinical value of cardiac color ultrasound and cardiac troponin T (cTnT) combined with dynamic electrocardiogram in evaluating the treatment effect on acute pulmonary embolism (APE) was investigated. Ninety-eight patients with APE treated in Jinan Zhangqiu District Hospital of TCM from March 2016 to February 2017 were selected, and they were examined via the cardiac color ultrasound, cTnT and dynamic electrocardiogram to evaluate the clinical value in the treatment of pulmonary embolism. Electrocardiogram showed that there was no significant difference in the poor prognosis rate between right ventricular strain group and non-right ventricular strain group (P>0.05); the poor prognosis rate in cTnT positive group was significantly higher than that in cTnT negative group (P<0.05). Moreover, the ultrasonic cardiogram revealed that the poor prognosis rate in right ventricular dysfunction group was significantly higher than that in non-right ventricular dysfunction group (P<0.05). It was found in the receiver operating characteristic (ROC) curve analysis that the areas under the curve (AUC) of ROC detected via cardiac color ultrasound and cTnT were >0.9, while that detected via dynamic electrocardiogram was <0.7. Besides, logistic regression analysis showed that cTnT and right ventricular dysfunction were the risk factors affecting the poor prognosis of patients with APE (P<0.05). In conclusion, cardiac color ultrasound can predict the prognosis of patients with APE through monitoring the right ventricular function; cTnT can also evaluate the prognosis of APE; but the electrocardiogram has little significance in evaluating the prognosis of APE.
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Affiliation(s)
- Hongjun Li
- Electrocardiograph Room, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, Shandong 250200, P.R. China
| | - Lixin Kang
- Physical Examination Center, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, Shandong 250200, P.R. China
| | - Yongqiang Sun
- Department of Orthopedics, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, Shandong 250200, P.R. China
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Nie J, Zhang H, Kong Z, George K, Little JP, Tong TK, Li F, Shi Q. Impact of high-intensity interval training and moderate-intensity continuous training on resting and postexercise cardiac troponin T concentration. Exp Physiol 2018; 103:370-380. [PMID: 29247498 DOI: 10.1113/ep086767] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/13/2017] [Indexed: 12/17/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does exercise training impact resting and postexercise cardiac troponin T (cTnT) concentration? What is the main finding and its importance? This randomized controlled intervention study demonstrated that 12 weeks of either high-intensity interval training or moderate-intensity continuous training largely abolished the exercise-induced elevation in cTnT when exercise was performed at the same absolute intensity. There was no impact of training on resting cTnT or postexercise appearance of cTnT when exercise was performed at the same relative intensity. These findings provide new information that might help clinicians with decision-making in relationship to basal and postexercise values of cTnT in individuals with different training status. ABSTRACT We evaluated the influence of 12 weeks of high-intensity interval training [HIIT; repeated 4 min cycling at 90% of maximal oxygen uptake (V̇O2max) interspersed with 3 min rest, 200-300 kJ per session, 3 or 4 days each week] and work-equivalent moderate-intensity continuous training (MICT; continuous cycling at 60% V̇O2max) on resting cardiac troponin T (cTnT) and the appearance of exercise-induced cTnT. Forty-eight sedentary obese young women were randomly assigned to HIIT, MICT or a control group. The V̇O2max and body composition were measured before and after training. At baseline, cTnT was assessed using a high-sensitivity assay at rest and immediately, 2 and 4 h after 45 min cycling at 60% V̇O2max. After a 12 week training period, cTnT was assessed before and after 45 min cycling at the same relative and absolute intensities as before training. Training led to higher V̇O2max and lower fat mass in both HIIT and MICT groups (all P < 0.05). Before training, cTnT was significantly elevated in all three groups (by 35-118%, all P < 0.05) with acute exercise. After training, both resting and postexercise cTnT concentrations (same relative intensity) were similar to pretraining values. In contrast, postexercise cTnT (same absolute intensity, which represented a smaller exercise stimulus) was not elevated from rest in both HIIT and MICT groups. In conclusion, 12 weeks of either HIIT or MICT largely abolished the postexercise elevation of cTnT concentration when exercise was performed at the same absolute intensity. There was, however, no impact of training on resting cTnT or postexercise appearance of cTnT for exercise performed at the same relative intensity.
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Affiliation(s)
- Jinlei Nie
- School of Physical Education and Sports, Macao Polytechnic Institute, Macao, China
| | - Haifeng Zhang
- College of Physical Education, Hebei Normal University, Hebei, China
| | - Zhaowei Kong
- Faculty of Education, University of Macau, Macao, China
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jonathan P Little
- School of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Tomas K Tong
- Dr Stephen Hui Research Centre for Physical Recreation and Wellness, Department of Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Feifei Li
- College of Physical Education, Hebei Normal University, Hebei, China
| | - Qingde Shi
- School of Physical Education and Sports, Macao Polytechnic Institute, Macao, China
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Duma A, Wagner C, Titz M, Maleczek M, Hüpfl M, Weihs VB, Samaha E, Herkner H, Szekeres T, Mittlboeck M, Scott MG, Jaffe AS, Nagele P. High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery. Br J Anaesth 2017; 120:291-298. [PMID: 29406178 DOI: 10.1016/j.bja.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is unclear if isolated postoperative cardiac-troponin elevation, often referred to as myocardial injury, represents a pathological event, as control studies in otherwise healthy adults are lacking. METHODS In this single-centre prospective observational cohort study, serial high-sensitivity cardiac troponin T (hscTnT) plasma concentrations were obtained from young, healthy adults undergoing elective orthopaedic surgery at three time points: before operation, 2-6 h, and 18-30 h after surgery. End points were hscTnT increases after surgery: ≥20% (exceeding analytical variability), ≥50% (exceeding short-term biological variability), and ≥85% (exceeding long-term biological variability). The secondary end point was myocardial injury, defined as new postoperative hscTnT elevation >99th % upper reference limit (URL) (women >10 ng litre-1; men >15 ng litre-1). RESULTS Amongst the study population (n=95), no hscTnT increase ≥20% was detected in 68 patients (73%). A hscTnT increase between 20% and 49% was observed in 17 patients (18%), 50-84% in seven patients (7%), and ≥85% in three patients (3%). Twenty patients (21%) had an absolute ΔhscTnT between 0 and 2 ng litre-1, 12 patients (13%) between 2 and 4 ng litre-1, three patients between 4 and 6 ng litre-1, and one patient (1%) between 6 and 8 ng litre-1. Myocardial injury (new hscTnT elevation >99th%) was diagnosed in one patient (1%). The median hscTnT concentrations did not increase after operation, and were 4 (3.9-5, inter-quartile range) ng litre-1 at baseline, 4 (3.9-5) ng litre-1 at 2-6 h after surgery, and 4 (3.9-5) ng litre-1 on postoperative day 1. CONCLUSIONS One in four young adult patients without known cardiovascular disease developed a postoperative hscTnT increase, but without exceeding the 99th% URL and without evidence of myocardial ischaemia. These results may have important ramifications for the concept of postoperative myocardial injury, as they suggest that, in some patients, postoperative cardiac-troponin increases may be the result of a normal physiological process in the surgical setting. CLINICAL TRIAL REGISTRATION NCT 02394288.
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Affiliation(s)
- A Duma
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - C Wagner
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Titz
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Maleczek
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Hüpfl
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - V B Weihs
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - E Samaha
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria; Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
| | - H Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - T Szekeres
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Mittlboeck
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - M G Scott
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - A S Jaffe
- Cardiovascular Division, Department of Internal Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA; Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - P Nagele
- Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA.
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Legaz-Arrese A, Carranza-García LE, Navarro-Orocio R, Valadez-Lira A, Mayolas-Pi C, Munguía-Izquierdo D, Reverter-Masía J, George K. Cardiac Biomarker Release after Endurance Exercise in Male and Female Adults and Adolescents. J Pediatr 2017; 191:96-102. [PMID: 29173327 DOI: 10.1016/j.jpeds.2017.08.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/18/2017] [Accepted: 08/22/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To compare the responses of high-sensitivity cardiac troponin T (hs-cTnT) and NH2-terminal probrain natriuretic peptide (NT-proBNP) after 60 minutes of swimming in male and female adults and adolescents with different pubertal status. STUDY DESIGN Adolescent swimmers (25 male and 25 female) and adult swimmers (7 male and 9 female) participated in a 60-minute maximal swimming test with serial assessment of hs-cTnT and NT-proBNP at rest, immediately postexercise, and at 1, 3, 6, 12, and 24 hours postexercise. Adolescents were classified according to pubertal status: Tanner stages 3 (n = 14), 4 (n = 22), and 5 (n = 14). RESULTS Exercise resulted in an increase in both biomarkers. hs-cTnT responses to exercise were similar in adolescents with different pubertal status and adults, although there was substantial individual variability in peak hs-cTnT, with the upper reference limit exceeding in 62% of the participants. Postexercise kinetics for hs-cTnT were largely consistent across all groups with a return to near baseline levels 24 hours postexercise. The male participants showed higher values of hs-cTnT at baseline and postexercise. All groups had similar NT-proBNP responses to acute exercise and recovery. One swimmer exceeded the upper reference limit for NT-proBNP. CONCLUSIONS An exercise-associated increase in hs-cTnT and NT-proBNP occurred in response to a 60-minute maximal swimming test that was independent of pubertal status/adolescent vs adults. The present data also suggests that baseline and postexercise hs-cTnT values are higher in male compared with female, with no sex differences in NT-proBNP values.
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Affiliation(s)
| | | | | | - Alberto Valadez-Lira
- School of Biological Sciences, Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Carmen Mayolas-Pi
- Section of Physical Education and Sports, University of Zaragoza, Zaragoza, Spain
| | - Diego Munguía-Izquierdo
- Department of Sports and Computer Science, Section of Physical Education and Sports, Universidad Pablo de Olavide, Sevilla, Spain
| | | | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Baird MF, Grace F, Sculthorpe N, Graham SM, Fleming A, Baker JS. Evidence of direct cardiac damage following high-intensity exercise in chronic energy restriction: A case report and literature review. Medicine (Baltimore) 2017; 96:e7030. [PMID: 28682862 PMCID: PMC5502135 DOI: 10.1097/md.0000000000007030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Following prolonged endurance events such as marathons, elevated levels of cardiospecific biomarkers are commonly reported. Although transiently raised levels are generally not considered to indicate clinical myocardial damage, comprehension of this phenomenon remains incomplete. The popularity of high-intensity interval training highlights a paucity of research measuring cardiac biomarker response to this type of exercise. This a posteriori case report discusses the elevation of cardiac troponins (cTn) associated with short interval, high-intensity exercise. PATIENT CONCERNS In this case report, an apparently healthy 29-year-old recreationally active female presented clinically raised cardiac troponin I (cTnI) levels (>0.04 ng/mL), after performing high-intensity cycle ergometer sprints. As creatine kinase (CK) is expressed by multiple organs (e.g., skeletal muscle, brain, and myocardium), cTnI assays were performed to determine any changes in total serum CK levels not originating from skeletal muscle damage. DIAGNOSIS A posteriori the individual's daily energy expenditure indicated chronically low-energy availability. Psychometric testing suggested that the individual scored positive for disordered eating, highly for fatigue levels, and low in mental health components. OUTCOMES The current case report provides novel evidence of elevated cTnI occurring as a result of performing short duration, high intensity, cycle ergometer exercise in an individual with self-reported chronically depleted energy balance. A schematic to identify potentially "at risk" individuals is presented. LESSONS Considering this as a case report, results cannot be generalized; however, the main findings suggest that individuals who habitually restrict their calorie intake below their bodies' daily energy requirements, may have elevated biomarkers of exercise induced myocardial stress from performing high-intensity exercise.
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Affiliation(s)
- Marianne F. Baird
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, UK
| | - Fergal Grace
- Faculty of Health, Federation University, Ballarat, Victoria, Australia
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, UK
| | - Scott M. Graham
- School of Applied Sciences, Edinburgh Napier University, Edinburgh
| | - Audrey Fleming
- Faculty of Humanities and Social Sciences, Strathclyde University, Glasgow, UK
| | - Julien S. Baker
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, UK
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57
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Hunter AL, Shah ASV, Langrish JP, Raftis JB, Lucking AJ, Brittan M, Venkatasubramanian S, Stables CL, Stelzle D, Marshall J, Graveling R, Flapan AD, Newby DE, Mills NL. Fire Simulation and Cardiovascular Health in Firefighters. Circulation 2017; 135:1284-1295. [PMID: 28373523 PMCID: PMC5377985 DOI: 10.1161/circulationaha.116.025711] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rates of myocardial infarction in firefighters are increased during fire suppression duties, and are likely to reflect a combination of factors including extreme physical exertion and heat exposure. We assessed the effects of simulated fire suppression on measures of cardiovascular health in healthy firefighters. METHODS In an open-label randomized crossover study, 19 healthy firefighters (age, 41±7 years; 16 males) performed a standardized training exercise in a fire simulation facility or light duties for 20 minutes. After each exposure, ex vivo thrombus formation, fibrinolysis, platelet activation, and forearm blood flow in response to intra-arterial infusions of endothelial-dependent and -independent vasodilators were measured. RESULTS After fire simulation training, core temperature increased (1.0±0.1°C) and weight reduced (0.46±0.14 kg, P<0.001 for both). In comparison with control, exposure to fire simulation increased thrombus formation under low-shear (73±14%) and high-shear (66±14%) conditions (P<0.001 for both) and increased platelet-monocyte binding (7±10%, P=0.03). There was a dose-dependent increase in forearm blood flow with all vasodilators (P<0.001), which was attenuated by fire simulation in response to acetylcholine (P=0.01) and sodium nitroprusside (P=0.004). This was associated with a rise in fibrinolytic capacity, asymptomatic myocardial ischemia, and an increase in plasma cardiac troponin I concentrations (1.4 [0.8-2.5] versus 3.0 [1.7-6.4] ng/L, P=0.010). CONCLUSIONS Exposure to extreme heat and physical exertion during fire suppression activates platelets, increases thrombus formation, impairs vascular function, and promotes myocardial ischemia and injury in healthy firefighters. Our findings provide pathogenic mechanisms to explain the association between fire suppression activity and acute myocardial infarction in firefighters. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01812317.
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Affiliation(s)
- Amanda L Hunter
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Anoop S V Shah
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Jeremy P Langrish
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Jennifer B Raftis
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Andrew J Lucking
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Mairi Brittan
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Sowmya Venkatasubramanian
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Catherine L Stables
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Dominik Stelzle
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - James Marshall
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Richard Graveling
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Andrew D Flapan
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - David E Newby
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.)
| | - Nicholas L Mills
- From British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.L.H., A.S.V.S., J.P.L., A.J.L., M.B., S.V., C.L.S., D.S., D.E.N., N.L.M.); ELEGI/Colt Laboratories, Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queens Medical Research Institute, United Kingdom (J.B.R.); Scottish Fire and Rescue Service, Edinburgh, United Kingdom (J.M.); Institute of Occupational Medicine, Edinburgh, United Kingdom (R.G.); and Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (A.D.F.).
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Kavsak PA. Stressing the Utility of High-Sensitivity Cardiac Troponin Testing in Patients with Possible Cardiac Ischemia. J Appl Lab Med 2017; 1:468-470. [PMID: 33379791 DOI: 10.1373/jalm.2016.022491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Cwikiel J, Seljeflot I, Berge E, Arnesen H, Wachtell K, Ulsaker H, Flaa A. Pro-coagulant activity during exercise testing in patients with coronary artery disease. Thromb J 2017; 15:3. [PMID: 28115916 PMCID: PMC5247809 DOI: 10.1186/s12959-016-0127-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/27/2016] [Indexed: 01/08/2023] Open
Abstract
Background Strenuous exercise may trigger myocardial infarction through increased pro-coagulant activity. We aimed to investigate whether patients referred for exercise testing, who were found to have angiographically verified coronary artery disease (CAD), have a more hypercoagulable profile during exercise testing than those without CAD. Methods Patients with symptoms of stable CAD were examined with exercise electrocardiography on bicycle ergometer. Venous blood samples were taken at rest and within 5 min after end of exercise. The following haemostatic variables were analyzed: tissue factor pathway inhibitor (TFPI) activity and antigen, prothrombin fragment 1 + 2 (F1 + 2), D-dimer and endogenous thrombin potential (ETP). All participants underwent conventional coronary angiography. CAD was defined as having any degree of atherosclerosis. Results Out of the 106 patients enrolled, 70 were found to have CAD. Mean exercise duration was 10:06 ± 4:11 min, with no significant differences between the groups. A significant increase from baseline to after exercise testing was observed in all measured markers in the total population (p ≤ 0.002 for all). In patients with angiographically verified CAD, total TFPI was significantly lower at baseline compared to patients without CAD (median value 67.4 and 76.6 ng/ml respectively, p = 0.027). However, no significant differences in changes of any of the measured markers during exercise were observed between the two groups. Conclusion Pro-coagulant activity increased during short-term strenuous exercise testing in patients with symptoms suggestive of CAD. However the hypercoagulable state observed, was not more pronounced in patients with angiographically verified CAD compared to patients without CAD. NCT01495091.
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Affiliation(s)
- Joanna Cwikiel
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevaal, PB 4956 Nydalen, 0424 Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Section of Cardiovascular and Renal research, Oslo University Hospital Ulleval, Oslo, Norway
| | - Ingebjorg Seljeflot
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevaal, PB 4956 Nydalen, 0424 Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Harald Arnesen
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevaal, PB 4956 Nydalen, 0424 Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristian Wachtell
- Department of Cardiology, Division of Cardiovascular and Pulmonary diseases, Oslo University Hospital, Oslo, Norway
| | | | - Arnljot Flaa
- Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Section of Cardiovascular and Renal research, Oslo University Hospital Ulleval, Oslo, Norway
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60
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Aengevaeren VL, Hopman MT, Thijssen DH, van Kimmenade RR, de Boer MJ, Eijsvogels TM. Endurance exercise-induced changes in BNP concentrations in cardiovascular patients versus healthy controls. Int J Cardiol 2017; 227:430-435. [DOI: 10.1016/j.ijcard.2016.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022]
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Abstract
AbstractmicroRNAs are promising biomarkers for diverse cardiovascular diseases. While quantification of the small non-coding RNAs is routinely performed in the research laboratory, clinical-grade assessment of microRNAs in central laboratory environments or point-of-care testing is still in its infancy. In this review, we provide an overview on microRNAs as biomarkers for acute coronary syndromes and highlight promising technical approaches for microRNA-based assays systems.
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62
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Basso D, Padoan A, Laufer T, Aneloni V, Moz S, Schroers H, Pelloso M, Saiz A, Krapp M, Fogar P, Cornoldi P, Zambon CF, Rossi E, La Malfa M, Marotti A, Brefort T, Weis TM, Katus HA, Plebani M. Relevance of pre-analytical blood management on the emerging cardiovascular protein biomarkers TWEAK and HMGB1 and on miRNA serum and plasma profiling. Clin Biochem 2016; 50:186-193. [PMID: 27847340 DOI: 10.1016/j.clinbiochem.2016.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Disease-independent sources of biomarker variability include pre-analytical, analytical and biological variance. The aim of the present study was to evaluate whether the pre-analytical phase has any impact on the emerging heart disease TWEAK and HMGB1 protein markers and miRNA biomarkers, and whether peptidome profiling allows the identification of pre-analytical quality markers. METHODS An assessment was made of sample type (serum, EDTA-Plasma, Citrate-Plasma, ACD-plasma, Heparin-plasma), temperature of sample storage (room temperature or refrigerated), time of sample storage (0.5, 3, 6 and 9h) and centrifugation (one or two-step). Aliquots of all processed samples were immediately frozen (-80°C) before analysis. Proteins were assayed by ELISAs, miRNA expression profile by microarray and peptidome profiling by MALDI-TOF/MS. RESULTS Temperature, time and centrifugation had no impact on TWEAK and HMGB1 results, which were significantly influenced by matrix type, TWEAK levels being significantly higher (F=194.7, p<0.0001), and HMGB1 levels significantly lower (F=36.32, p<0.0001) in serum than in any other plasma type. Unsuitable miRNA results were obtained using Heparin-plasma. Serum miRNA expression profiles depended mainly on temperature, while EDTA-plasma miRNA expression profiles were strongly affected by the centrifugation method used. MALDI-TOF/MS allowed the identification of seven features as indices of pre-analytical serum (m/z at 1206, 1350, 1865 and 2021) or EDTA-plasma (m/z 1897, 2740 and 2917) degradation. CONCLUSIONS Serum and EDTA-plasma allow the analysis of both proteins and miRNA emerging biomarkers of heart diseases. Refrigerated storage prevents an altered miRNA expression profile also in cases of a prolonged time-interval between blood drawing and processing.
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Affiliation(s)
- Daniela Basso
- Department of Medicine - DIMED, University of Padova, Italy.
| | - Andrea Padoan
- Department of Medicine - DIMED, University of Padova, Italy
| | - Thomas Laufer
- Comprehensive Biomarker Center GmbH, Heidelberg, Germany
| | | | - Stefania Moz
- Department of Medicine - DIMED, University of Padova, Italy
| | | | | | - Anna Saiz
- Comprehensive Biomarker Center GmbH, Heidelberg, Germany
| | - Medea Krapp
- Comprehensive Biomarker Center GmbH, Heidelberg, Germany
| | - Paola Fogar
- Department of Medicine - DIMED, University of Padova, Italy
| | - Paola Cornoldi
- Department of Medicine - DIMED, University of Padova, Italy
| | | | - Elisa Rossi
- Department of Medicine - DIMED, University of Padova, Italy
| | - Marco La Malfa
- Department of Medicine - DIMED, University of Padova, Italy
| | - Alberto Marotti
- UOC Immunotrasfusionale, University-Hospital of Padova, Italy
| | - Thomas Brefort
- Comprehensive Biomarker Center GmbH, Heidelberg, Germany; Eurofins Medigenomix GmbH, Ebersberg, Germany
| | - Tanja M Weis
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mario Plebani
- Department of Medicine - DIMED, University of Padova, Italy
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63
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Niemelä M, Kangastupa P, Niemelä O, Bloigu R, Juvonen T. Individual responses in biomarkers of health after marathon and half-marathon running: is age a factor in troponin changes? Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:575-580. [DOI: 10.1080/00365513.2016.1225122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Markus Niemelä
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
| | - Päivikki Kangastupa
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, and University of Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, and University of Tampere, Finland
| | - Risto Bloigu
- Medical Informatics and Statistics Research Group, University of Oulu, Finland
| | - Tatu Juvonen
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
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64
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20 Things You Didn’t Know About Exercise. J Cardiovasc Nurs 2016; 31:387-9. [DOI: 10.1097/jcn.0000000000000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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65
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Hecksteden A, Leidinger P, Backes C, Rheinheimer S, Pfeiffer M, Ferrauti A, Kellmann M, Sedaghat-Hamedani F, Meder B, Meese E, Meyer T, Keller A. miRNAs and sports: tracking training status and potentially confounding diagnoses. J Transl Med 2016; 14:219. [PMID: 27456854 PMCID: PMC4960671 DOI: 10.1186/s12967-016-0974-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/11/2016] [Indexed: 11/27/2022] Open
Abstract
Background The dependency of miRNA abundance from physiological processes such as exercises remains partially understood. We set out to analyze the effect of physical exercises on miRNA profiles in blood and plasma of endurance and strength athletes in a systematic manner and correlated differentially abundant miRNAs in athletes to disease miRNAs biomarkers towards a better understanding of how physical exercise may confound disease diagnosis by miRNAs. Methods We profiled blood and plasma of 29 athletes before and after exercise. With four samples analyzed for each individual we analyzed 116 full miRNomes. The study set-up enabled paired analyses of individuals. Affected miRNAs were investigated for known disease associations using network analysis. Results MiRNA patterns in blood and plasma of endurance and strength athletes vary significantly with differences in blood outreaching variations in plasma. We found only moderate differences between the miRNA levels before training and the RNA levels after training as compared to the more obvious variations found between strength athletes and endurance athletes. We observed significant variations in the abundance of miR-140-3p that is a known circulating disease markers (raw and adjusted p value of 5 × 10−12 and 4 × 10−7). Similarly, the levels of miR-140-5p and miR-650, both of which have been reported as makers for a wide range of human pathologies significantly depend on the training mode. Among the most affected disease categories we found acute myocardial infarction. MiRNAs, which are up-regulated in endurance athletes inhibit VEGFA as shown by systems biology analysis of experimentally validated target genes. Conclusion We provide evidence that the mode and the extent of training are important confounding factors for a miRNA based disease diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0974-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Hecksteden
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Petra Leidinger
- Department of Human Genetics, Saarland University, Saarbrücken, Germany
| | - Christina Backes
- Chair for Clinical Bioinformatics, Medical Department, Saarland University, Building E2.1, 66125, Saarbrücken, Germany
| | | | - Mark Pfeiffer
- Department of Theory and Practice of Sports, Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - Michael Kellmann
- Faculty of Sport Science, Ruhr-University Bochum, Bochum, Germany.,School of Human Movement Studies, The University of Queensland, St Lucia, Australia
| | | | - Benjamin Meder
- Internal Medicine, Heidelberg University, Heidelberg, Germany
| | - Eckart Meese
- Department of Human Genetics, Saarland University, Saarbrücken, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Medical Department, Saarland University, Building E2.1, 66125, Saarbrücken, Germany.
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66
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Influence of a 10-Day Mimic of Our Ancient Lifestyle on Anthropometrics and Parameters of Metabolism and Inflammation: The "Study of Origin". BIOMED RESEARCH INTERNATIONAL 2016; 2016:6935123. [PMID: 27366752 PMCID: PMC4913061 DOI: 10.1155/2016/6935123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/08/2016] [Accepted: 05/15/2016] [Indexed: 01/21/2023]
Abstract
Chronic low-grade inflammation and insulin resistance are intimately related entities that are common to most, if not all, chronic diseases of affluence. We hypothesized that a short-term intervention based on “ancient stress factors” may improve anthropometrics and clinical chemical indices. We executed a pilot study of whether a 10-day mimic of a hunter-gatherer lifestyle favorably affects anthropometrics and clinical chemical indices. Fifty-five apparently healthy subjects, in 5 groups, engaged in a 10-day trip through the Pyrenees. They walked 14 km/day on average, carrying an 8-kilo backpack. Raw food was provided and self-prepared and water was obtained from waterholes. They slept outside in sleeping bags and were exposed to temperatures ranging from 12 to 42°C. Anthropometric data and fasting blood samples were collected at baseline and the study end. We found important significant changes in most outcomes favoring better metabolic functioning and improved anthropometrics. Coping with “ancient mild stress factors,” including physical exercise, thirst, hunger, and climate, may influence immune status and improve anthropometrics and metabolic indices in healthy subjects and possibly patients suffering from metabolic and immunological disorders.
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67
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Mereles D, Aurich M, Greiner S, Riffel J, Buss SJ, Kristen AV, Katus HA. Diagnosis of cardiac involvement in systemic amyloidosis by state-of-the-art echocardiography: where are we now? Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1179573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Derliz Mereles
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Aurich
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Greiner
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian J. Buss
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Arnt V. Kristen
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
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68
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Use of high sensitivity cardiac troponin assays as an adjunct to cardiac stress testing. Clin Biochem 2016; 49:419-420. [DOI: 10.1016/j.clinbiochem.2016.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/05/2016] [Indexed: 01/06/2023]
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69
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Huskens D, Roest M, Remijn JA, Konings J, Kremers RMW, Bloemen S, Schurgers E, Selmeczi A, Kelchtermans H, van Meel R, Meex SJ, Kleinegris MC, de Groot PG, Urbanus RT, Ninivaggi M, de Laat B. Strenuous exercise induces a hyperreactive rebalanced haemostatic state that is more pronounced in men. Thromb Haemost 2016; 115:1109-19. [PMID: 26864794 DOI: 10.1160/th15-10-0821] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/07/2016] [Indexed: 11/05/2022]
Abstract
Physical exercise is recommended for a healthy lifestyle. Strenuous exercise, however, may trigger the haemostatic system, increasing the risk of vascular thrombotic events and the incidence of primary cardiac arrest. Our goal was to study the effects of strenuous exercise on risk factors of cardiovascular disease. Blood was collected from 92 healthy volunteers who participated in the amateur version of the pro-tour Amstel Gold cycling race, before and directly after the race. Thrombin generation showed a shortening of the lag time and time to peak and an increase of the velocity index. Interestingly, the endogenous thrombin potential measured in plasma decreased due to reduced prothrombin conversion. Platelet reactivity increased and this effect was stronger in men than in women. Lower fibrinogen and higher D-dimer levels after exercise indicated higher fibrin formation. On the other hand, fibrinolysis was also elevated as indicated by a shortening of the clot lysis time. Exercise activated the endothelium (von Willebrand factor (VWF) and active VWF levels were elevated) and the immune system (concentrations IL-6, IL-8, MCP-1, RANTES and PDGF increased). Additionally, an increased cardiac troponin T level was measured post-exercise. Strenuous exercise induces a temporary hyperreactive state in the body with enhanced pro- and anticoagulant responses. As strenuous exercise has a more pronounced effect on platelet function in male subjects, this gives a possible explanation for the higher incidence of sudden cardiac death during exercise compared to women. This trial is registered at www.clinicaltrials.gov as NCT02048462.
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Affiliation(s)
- Dana Huskens
- Dana Huskens, Oxfordlaan 70, Maastricht 6229EV, The Netherlands, Tel.: +31 43 388 58 96, Fax: +31 43 388 45 70, E-mail:
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