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Papamichail A, Androulakis E, Xanthopoulos A, Briasoulis A. Effect of Training Load on Post-Exercise Cardiac Biomarkers in Healthy Children and Adolescents: A Systematic Review of the Existing Literature. J Clin Med 2023; 12:jcm12062419. [PMID: 36983423 PMCID: PMC10056214 DOI: 10.3390/jcm12062419] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postexercise release of cardiac biomarkers (cardiac troponins, cTn, and N-terminal pro b-type natriuretic peptide, NT-proBNP) is a well-known phenomenon in adults, although it remains unclear how it manifests in children. The aim of this review is to compare the pre-exercise with the post-exercise measurement of serum cardiac biomarkers, as well as to analyze their post-exercise release based on age, sex, and exercise intensity and duration. METHODS The terms troponin, football, swimmers, marathon, run, and exercise were used in a literature search at National Library of Medicine. The search was further refined by adding the keywords athletes, children, adolescents, and sport. RESULTS Fifteen pediatric studies and four studies with a mixed population of adults and children totaled 19 studies for the final analysis. In addition to them, some adult studies have been included for comparison. The kinetics of the cTn and NT-proBNP response after exercise have been the subject of our interest. While the impact of sport type, age, and sex has not yet been fully characterized, the existing data points to considerable impacts of sport intensity and duration on post-exercise biomarkers elevation. Most of the findings came from endurance sports, but the evidence is sparse. Furthermore, there is only limited data on women and less on young adults, African Caribbeans, and professional athletes. CONCLUSIONS Both amateur and competitive athletes can exhibit post-exercise release of both cTn and NT-proBNP. This is transient and lacks pathological significance, in contrast with adult population, in which exercise-induced increases in in these biomarker levels may not always be benign. While NT-proBNP release is still primarily driven by activity duration, cTnT release is additionally affected by exercise intensity. To define individual ranges of normality for postexercise cTn and NT-proBNP elevation, the role of several confounders (age, sex, sport type/intensity etc.) remains to be further elucidated.
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Affiliation(s)
| | - Emmanuel Androulakis
- Cardiology Department, St George's University of London, Blackshaw Road, London SW17 0QT, UK
| | - Andrew Xanthopoulos
- Medical School of Athens, National and Kapodistrian University of Athens, Goudi, 11527 Athens, Greece
| | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, Goudi, 11527 Athens, Greece
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Gutierrez-Carretero E, Mayoral-González I, Jesús Morón F, Fernández-Quero M, Domínguez-Rodríguez A, Ordóñez A, Smani T. miR-30b-5p Downregulation as a Predictive Biomarker of Coronary In-Stent Restenosis. Biomedicines 2021; 9:354. [PMID: 33808387 PMCID: PMC8066146 DOI: 10.3390/biomedicines9040354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/26/2021] [Indexed: 12/15/2022] Open
Abstract
In-stent restenosis (ISR) is one of the main limitations of percutaneous coronary intervention (PCI) therapy with drug-eluting stents (DES) implantation. The aim of this study was to determine if circulating microRNAs (miRNAs) have diagnostic capability for determining ISR in a cohort of matched patients. Blood samples were collected from 55 patients who underwent previously PCI and were readmitted for a new coronary angiography. Patients were divided into subgroups comprising patients who presented ISR or not (non-ISR). A microarray analysis determined that up to 49 miRNAs were differentially expressed between ISR and non-ISR patients. Of these, 10 miRNAs are related to vascular smooth muscle and endothelial cells proliferation, migration, and differentiation, well-known hallmarks of vascular remodeling. Additionally, we identified that the expression of miR-30b-5p is significantly lower in serum samples of ISR patients, as compared to non-ISR. A further analysis demonstrated that miR-30b-5p provides better values of the receiver operator characteristic curve than other miRNAs and biochemical parameters. Finally, the in-silico analysis suggests that miR-30b-5p is predicted to target 62 genes involved in different signaling pathways involved in vascular remodeling. In conclusion, we determined for the first time that circulating mi-R30b-5p can reliably prognose restenosis in patient with implanted DES, which could be potentially helpful in the establishment of an early diagnosis and therapy of ISR.
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Affiliation(s)
- Encarnación Gutierrez-Carretero
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
- Department of Surgery, Faculty of Medicine, University of Seville, 41009 Sevilla, Spain
- University Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | - Isabel Mayoral-González
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
- Department of Surgery, Faculty of Medicine, University of Seville, 41009 Sevilla, Spain
| | - Francisco Jesús Morón
- Genomic Facility, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain;
| | | | - Alejandro Domínguez-Rodríguez
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
| | - Antonio Ordóñez
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
- Department of Surgery, Faculty of Medicine, University of Seville, 41009 Sevilla, Spain
| | - Tarik Smani
- Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CSIC, 41013 Seville, Spain; (E.G.-C.); (I.M.-G.); (A.D.-R.); (A.O.)
- Department of Medical Physiology and Biophysics, Faculty of Medicine, University of Seville, 41009 Seville, Spain
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Post-exercise high-sensitivity troponin T levels in patients with suspected unstable angina. PLoS One 2019; 14:e0222230. [PMID: 31498833 PMCID: PMC6733469 DOI: 10.1371/journal.pone.0222230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/23/2019] [Indexed: 11/19/2022] Open
Abstract
Background Previous studies showed that troponin blood levels may increase after exercise. In this study we assessed whether, among patients admitted with suspected unstable angina, the increase in high-sensitive troponin T (hs-TnT) levels after exercise stress test (EST) might help identify those with obstructive coronary artery disease (CAD) and predict symptom recurrence during short term follow-up. Methods Maximal treadmill EST was performed in 69 consecutive patients admitted to the emergency room with a suspicion of unstable angina (acute chest pain but confirmed normal serum levels of cardiac troponins) was measured before and 4 hours after EST. Coronary angiography was performed in 22 patients (32.8%). Results hs-TnT increased after EST compared to baseline in the whole population (from 0.84±0.65 to 1.17±0.87 ng/dL, p<0.001). The increase was similar in patients with positive (n = 14) and negative (n = 55) EST (p = 0.72), and was also similar in patients with (n = 12) and without (n = 10) obstructive CAD at angiography (p = 0.91). The achievement of a heart rate at peak EST ≥85% of that predicted for age was the variable mainly associated with the post-EST hs-TnT increase at multivariable linear regression analysis (p = 0.005). The change after EST of hs-TnT did not predict the recurrence of symptoms or readmission for chest pain at 6-month follow-up. Conclusions Our data show that hs-TnT increased after EST in patients with suspected unstable angina, which seemed largely independent of most clinical and laboratory variables. Thus, hs-TnT assessed after EST does not seem to be helpful to identify patients with obstructive CAD in this kind of patients.
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Liu MY, Yang Y, Zhang LJ, Pu LH, He DF, Liu JY, Hafeez A, Ding YC, Ma H, Geng QS. Potential predictors for mental stress-induced myocardial ischemia in patients with coronary artery disease. Chin Med J (Engl) 2019; 132:1390-1399. [PMID: 31205095 PMCID: PMC6629334 DOI: 10.1097/cm9.0000000000000260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in patients with coronary artery disease (CAD) and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI. METHODS This study enrolled 82 patients with documented CAD between June 1, 2017 and November 9, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, and logistic regression. RESULTS Patients with CAD with MSIMI had significantly greater median resting N-terminal pro-brain natriuretic peptide (NT-proBNP, 141.02 [45.85-202.76] pg/mL vs. 57.95 [27.06-117.64] pg/mL; Z = -2.23, P = 0.03) and mean systolic blood pressure (SBP) (145.56 ± 16.87 mmHg vs. 134.92 ± 18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-min mental stress task, those who developed MSIMI presented higher elevation of median post-stressor high sensitivity cardiac troponin I (hs-cTnI, 0.020 [0.009-0.100] ng/mL vs. 0.009 [0.009-0.010] ng/mL; Z = -2.45, P = 0.01), post-stressor NT-proBNP (138.96 [39.93-201.56] pg/mL vs. 61.55 [25.66-86.50] pg/mL; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post-stressor hs-cTnI ≥ 0.015 ng/mL had seven-fold increase in the risk of developing MSIMI (odds ratio [OR]: 7.09; 95% confidence interval [CI]: 1.65-30.48; P = 0.009), a rest NT-proBNP ≥ 80.51 pg/mL had nearly eight-fold increase (OR: 7.85; 95% CI: 1.51-40.82; P = 0.014), a post-stressor NT-proBNP ≥ 98.80 pg/mL had 35-fold increase (OR: 34.96; 95% CI: 3.72-328.50; P = 0.002), a rest SBP ≥ 129.50 mmHg had 11-fold increase (OR: 11.42; 95% CI: 1.21-108.17; P = 0.034). CONCLUSIONS The present study shows that CAD patients with higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.
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Affiliation(s)
- Mei-Yan Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Ya Yang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Li-Jun Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Li-Hong Pu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Dong-Fang He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jian-Yang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Adam Hafeez
- Deparment of Internal Medicine, Beaumont Health affiliated with Oakland University William Beaumont School of Medicine, Royal Oak, MI 48201, USA
| | - Yu-Chuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Huan Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Qing-Shan Geng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
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Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis. Pediatr Exerc Sci 2019; 31:28-36. [PMID: 30269651 DOI: 10.1123/pes.2018-0058] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The authors evaluated the impact of acute exercise and 24-hour recovery on serum concentration of cardiac troponins T and I (cTnT and cTnI) and N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) in healthy children and adolescents. The authors also determined the proportion of participants exceeding the upper reference limits and acute myocardial infarction cutoff for each assay. METHOD Web of Science, SPORTDiscus, MEDLINE, ScienceDirect, and Scopus databases were systematically searched up to November 2017. Studies were screened and quality-assessed; the data was systematically extracted and analyzed. RESULTS From 751 studies initially identified, 14 met the inclusion criteria for data extraction. All 3 biomarkers were increased significantly after exercise. A decrease from postexercise to 24 hours was noted in cTnT and cTnI, although this decrease was only statistically significant for cTnT. The upper reference limit was exceeded by 76% of participants for cTnT, a 51% for cTnI, and a 13% for NT-proBNP. Furthermore, the cutoff value for acute myocardial infarction was exceeded by 39% for cTnT and a 11% for cTnI. Postexercise peak values of cTnT were associated with duration and intensity (Q(3) = 28.3, P < .001) while NT-proBNP peak values were associated with duration (Q(2) = 11.9, P = .003). CONCLUSION Exercise results in the appearance of elevated levels of cTnT, cTnI, and NT-proBNP in children and adolescents. Postexercise elevations of cTnT and NT-proBNP are associated with exercise duration and intensity.
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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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Elevated troponin I level assessed by a new high-sensitive assay and the risk of poor outcomes in patients with acute heart failure. Int J Cardiol 2017; 230:646-652. [PMID: 28069251 DOI: 10.1016/j.ijcard.2017.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The interpretation and clinical usefulness of elevated levels of cardiac troponins in acute heart failure (AHF) remain controversial. We aimed to characterize the relationship between changes in cardiac troponin I (measured using a new high-sensitive immunoassay by single-molecule counting technology, Singulex, Alameda, USA; hs-TnI) during first 48h of hospital stay and patients' characteristics and the outcomes. METHODS AND RESULTS We measured hs-TnI at baseline, after 24 and 48h in 130 AHF patients (mean age: 65±13years, 77% men). The percentage of patients with elevated hs-TnI (i.e., above the upper reference limit [URL]>10.19pg/mL) were: on admission - 59%, after 24h - 61%, and after 48h - 58%. Elevated baseline level of hs-TnI was associated with more severe dyspnoea on admission but neither peak level nor changes in hs-TnI during first 48h were related to the dyspnoea severity or magnitude of dyspnoea relief. During 1-year follow-up there were 32 (25%) cardiovascular deaths. Neither absolute baseline nor peak values of hs-TnI predicted cardiovascular mortality. Only changes in hs-TnI were independently associated with cardiovascular mortality with the strongest relationship seen in peak change in hs-TnI: patients with an increase vs. remaining patients - hazard ratio (95% confidence interval): 3.22 (1.52-6.82)p=0.002. CONCLUSIONS Using the new assay (proved to be more sensitive that the other available troponin assays) we observed that approximately 60% of patients with AHF presented elevated hs-TnI above URL during first 48h of hospital stay. Only significant increase in hs-TnI predicted cardiovascular mortality.
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