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Legaz-Arrese A, Sitko S, Cirer-Sastre R, Mayolas-Pi C, Jiménez-Gaytán RR, Orocio RN, García RL, Corral PGM, Reverter-Masia J, George K, Carranza-García LE. The kinetics of cardiac troponin T release during and after 1- and 6-h maximal cycling trials. J Sci Med Sport 2024:S1440-2440(24)00492-4. [PMID: 39277491 DOI: 10.1016/j.jsams.2024.08.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 08/01/2024] [Accepted: 08/23/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES In this study, the effects of short-duration high-intensity exercise and long-duration exercise on high-sensitivity cardiac troponin T (hs-cTnT) levels were compared. METHODS Twelve male amateur cyclists performed 1- and 6-h cycling trials. In both exercise trials, hs-cTnT was assessed at rest, immediately postexercise and at 1, 3, 6, 12, and 24 h postexercise. Additionally, hs-cTnT levels were assessed every hour during the 6-h trial. RESULTS Exercise resulted in an increase in hs-cTnT levels in all subjects. Circulating hs-cTnT levels increased in both exercise trials (p < 0.001), with higher peak values occurring after the 1-h trial compared with those of the 6-h trial (p = 0.023). The upper reference limit (URL) exceeded 83 % of the participants in the 1-h trial and 42 % of the participants in the 6-h trial. There was substantial individual variability in peak hs-cTnT in both trials. Values of hs-cTnT were greater after exercise than during exercise for the 6-h trial. For both exercise trials, the maximum postexercise hs-cTnT values correlated with the %HRMAX (r = 0.906 for the 1-h trial, r = 0.735 for the 6-h trial). For the 1-h trial, the maximum postexercise hs-cTnT values were observed at 3 h in all subjects. No significant difference in the hs-cTnT values was observed for the 6-h trial during the first 12 h postexercise. CONCLUSIONS Our results demonstrated greater hs-cTnT levels in young male participants after a 1-h cycling trial than after a 6-h cycling trial, despite a substantially greater energy expenditure and total external work completed in the 6-h trial. Postexercise hs-cTnT values are associated with relative exercise intensity.
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Affiliation(s)
- Alejandro Legaz-Arrese
- Faculty of Health and Sport Sciences, University of Zaragoza, Spain; Human Movement Sport Research Group, Spain.
| | - Sebastian Sitko
- Faculty of Health and Sport Sciences, University of Zaragoza, Spain; Human Movement Sport Research Group, Spain. https://twitter.com/SitkoSebastian
| | - Rafel Cirer-Sastre
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida, Spain
| | - Carmen Mayolas-Pi
- Faculty of Health and Sport Sciences, University of Zaragoza, Spain; Human Movement Sport Research Group, Spain
| | | | | | | | | | | | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
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Erevik CB, Kleiven Ø, Frøysa V, Bjørkavoll-Bergseth M, Chivulescu M, Klæboe LG, Dejgaard L, Auestad B, Skadberg Ø, Melberg T, Urheim S, Haugaa K, Edvardsen T, Ørn S. Exercise-Induced Cardiac Troponin I Elevation Is Associated With Regional Alterations in Left Ventricular Strain in High-Troponin Responders. J Am Heart Assoc 2024; 13:e034382. [PMID: 39158569 DOI: 10.1161/jaha.124.034382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/02/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The implications of exercise-induced cardiac troponin elevation in healthy individuals are unclear. This study aimed to determine if individuals with a high exercise-induced cardiac troponin I (cTnI) response have alterations in myocardial function following high-intensity endurance exercise compared with normal-cTnI responders. METHODS AND RESULTS Study individuals were recruited from previous participants in a 91-km mountain bike cycling race (the North Sea Race) and were classified as high- (n=34) or normal-cTnI responders (n=25) based on maximal cTnI values after the recruitment race. The present study exposed all participants to 2 prolonged high-intensity exercises: a combined lactate threshold and cardiopulmonary exercise test and repeated participation in the North Sea Race. Echocardiography was performed before, immediately after, and 24 hours following exercise. All study individuals (n=59) had normal coronary arteries, and were aged 51±10 years; 46 (74%) were men. There were no differences in baseline characteristics between the high- and normal-cTnI responders. Maximal cTnI levels 3 hours after exercise were significantly higher in the high- compared with normal-cTnI group (P<0.001-0.027). Following exercise, there were no differences in global ventricular function between the 2 groups. In contrast, high-cTnI responders had significantly lower regional strain in the anteroseptal segments following exercise, with more profound changes after the race. CONCLUSIONS High-cTnI responders had lower anteroseptal segmental strain shortly after exercise than normal-cTnI responders. However, there were no permanent alterations in myocardial strain, indicating no short- or long-term adverse consequences of these exercise-induced alterations in myocardial function. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02166216.
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Affiliation(s)
| | - Øyunn Kleiven
- Department of Cardiology Stavanger University Hospital Stavanger Norway
| | - Vidar Frøysa
- Department of Cardiology Stavanger University Hospital Stavanger Norway
| | | | - Monica Chivulescu
- ProCardio Center for Innovation, Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Lars Gunnar Klæboe
- ProCardio Center for Innovation, Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Lars Dejgaard
- ProCardio Center for Innovation, Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics University of Stavanger Stavanger Norway
- Research Department Stavanger University Hospital Stavanger Norway
| | - Øyvind Skadberg
- Department of Biochemistry Stavanger University Hospital Stavanger Norway
| | - Tor Melberg
- Department of Cardiology Stavanger University Hospital Stavanger Norway
| | - Stig Urheim
- Department of Cardiology Bergen University Hospital Bergen Norway
| | - Kristina Haugaa
- ProCardio Center for Innovation, Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Stein Ørn
- Department of Cardiology Stavanger University Hospital Stavanger Norway
- Department of Electrical Engineering and Computer Science University of Stavanger Stavanger Norway
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3
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Bjorkavoll-Bergseth M, Erevik C, Kleiven Ø, Wiktorski T, Auestad B, Skadberg Ø, Aakre KM, Eijsvogels TMH, Ørn S. The relationship between workload and exercise-induced cardiac troponin elevations is influenced by non-obstructive coronary atherosclerosis. Scand J Med Sci Sports 2024; 34:e14667. [PMID: 38773919 DOI: 10.1111/sms.14667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024]
Abstract
The relationship between exercise-induced troponin elevation and non-obstructive coronary artery disease (CAD) is unclear. This observational study assessed non-obstructive CAD's impact on exercise-induced cardiac Troponin I (cTnI) elevation in middle-aged recreational athletes. cTnI levels of 40 well-trained recreational athletes (73% males, 50 ± 9 years old) were assessed by a high-sensitive cTnI assay 24 h before, and at 3 and 24 h following two high-intensity exercises of different durations; a cardiopulmonary exercise test (CPET), and a 91-km mountain bike race. Workload was measured with power meters. Coronary computed tomography angiography was used to determine the presence or absence of non-obstructive (<50% obstruction) CAD. A total of 15 individuals had non-obstructive CAD (Atherosclerotic group), whereas 25 had no atherosclerosis (normal). There were higher post-exercise cTnI levels following the race compared with CPET, both at 3 h (77.0 (35.3-112.4) ng/L vs. 11.6 (6.4-22.5) ng/L, p < 0.001) and at 24 h (14.7 (6.7-16.3) vs. 5.0 (2.6-8.9) ng/L, p < 0.001). Absolute cTnI values did not differ among groups. Still, the association of cTnI response to power output was significantly stronger in the CAD versus Normal group both at 3 h post-exercise (Rho = 0.80, p < 0.001 vs. Rho = -0.20, p = 0.33) and 24-h post-exercise (Rho = 0.87, p < 0.001 vs. Rho = -0.13, p = 0.55). Exercise-induced cTnI elevation was strongly correlated with exercise workload in middle-aged athletes with non-obstructive CAD but not in individuals without CAD. This finding suggests that CAD influences the relationship between exercise workload and the cTnI response even without coronary artery obstruction.
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Affiliation(s)
- Magnus Bjorkavoll-Bergseth
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
- Clinical Institute II, University of Bergen, Bergen, Norway
| | - Christine Erevik
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Øyunn Kleiven
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Tomasz Wiktorski
- Department of Mathematics and Physics, The University of Stavanger, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, The University of Stavanger, Stavanger, Norway
- Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Skadberg
- Departement of Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Kristin M Aakre
- Department of Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Thijs M H Eijsvogels
- Department of Medical Biosciences, Exercise Physiology Research Group, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stein Ørn
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
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De Vita A, Bruno I, Baroni S, Moretti G, Tempestini F, Telesca A, Tremamunno S, Felici T, Verrillo A, Tempesta V, Feudo V, Lamendola P, Liuzzo G, Crea F, Giordano A, Lanza GA. Relation between high-sensitivity troponin I serum levels and myocardial ischemia in patients with suspected chronic coronary syndrome: The RESET-MI study. Eur J Intern Med 2024; 123:107-113. [PMID: 38000920 DOI: 10.1016/j.ejim.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Previous studies showed that exercise may increase cardiac troponin serum levels; whether the occurrence of myocardial ischemia influences the changes of exercise-induced troponin raise, however, remains debatable. METHODS We prospectively enrolled consecutive patients undergoing for the first time an elective stress myocardial perfusion scintigraphy (MPS) because of clinical suspicion of obstructive coronary artery disease (CAD). Patients were divided into 3 groups based on the evidence and degree of stress-induced myocardial ischemia at MPS: 1) group 1, no myocardial ischemia (≤4 %); 2) group 2, mild myocardial ischemia (5-10 %); 3) group 3, moderate-to-severe myocardial ischemia (≥10 %). High-sensitivity cardiac troponin I (cTnI) was measured immediately before (T0) and 1 hour (T1) and 4 h (T2) after the stress test. RESULTS One hundred-seven patients (71 males; age 65.6 ± 9.4 years) were enrolled in the study. Serum hs-cTnI concentrations (logarithmic values) significantly increased after MPS, compared to baseline, in the whole population, from 1.47±1.26 ng/L at T0, to 1.68±1.12 ng/L at T1 (p<0.001) and 2.15±1.02 ng/L at T2 (p<0.001 vs. both T0 and T1). The increase in hs-cTnI did not significantly differ between the 3 groups (p = 0.44). The heart rate achieved during the test was the strongest determinant of cTnI increase (p < 0.001) after the stress test. CONCLUSIONS In patients with suspected CAD, stress MPS induces an increase of cTnI that is independent of the induction and extension/severity of myocardial ischemia and is mainly related to myocardial work, as indicated by the heart rate achieved during the test.
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Affiliation(s)
- Antonio De Vita
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Isabella Bruno
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Baroni
- Department of laboratory and infectious disease, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Moretti
- Department of laboratory and infectious disease, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Tempestini
- Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Telesca
- Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Saverio Tremamunno
- Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Tamara Felici
- Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alfonso Verrillo
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria Tempesta
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vanessa Feudo
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Priscilla Lamendola
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Giordano
- Department of diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of diagnostic imaging, oncological radiotherapy and hematology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
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5
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Celeski M, Segreti A, Piscione M, Monticelli LM, Di Gioia G, Fossati C, Ussia GP, Pigozzi F, Grigioni F. The current paradigm of cardiac troponin increase among athletes. Monaldi Arch Chest Dis 2024. [PMID: 38700130 DOI: 10.4081/monaldi.2024.2878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/16/2024] [Indexed: 05/05/2024] Open
Abstract
Although it is known that exercise improves cardiovascular health and extends life expectancy, a significant number of people may also experience an elevation in cardiac troponin levels as a result of exercise. For many years, researchers have argued whether exercise-induced cardiac troponin rises are a consequence of a physiological or pathological reaction and whether they are clinically significant. Differences in cardiac troponin elevation and cardiac remodeling can be seen between athletes participating in different types of sports. When forecasting the exercise-induced cardiac troponin rise, there are many additional parameters to consider, as there is a large amount of interindividual heterogeneity in the degree of cardiac troponin elevation. Although it was previously believed that cardiac troponin increases in athletes represented a benign phenomenon, numerous recent studies disproved this notion by demonstrating that, in specific individuals, cardiac troponin increases may have clinical and prognostic repercussions. This review aims to examine the role of cardiac troponin in athletes and its role in various sporting contexts. This review also discusses potential prognostic and clinical implications, as well as future research methods, and provides a straightforward step-by-step algorithm to help clinicians interpret cardiac troponin rise in athletes in both ischemic and non-ischemic circumstances.
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Affiliation(s)
- Mihail Celeski
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Andrea Segreti
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Mariagrazia Piscione
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Luigi Maria Monticelli
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Giuseppe Di Gioia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico"; Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome.
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
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Janssen SLJE, de Vries F, Mingels AMA, Kleinnibbelink G, Hopman MTE, Mosterd A, Velthuis BK, Aengevaeren VL, Eijsvogels TMH. Exercise-induced cardiac troponin release in athletes with versus without coronary atherosclerosis. Am J Physiol Heart Circ Physiol 2024; 326:H1045-H1052. [PMID: 38363583 PMCID: PMC11279743 DOI: 10.1152/ajpheart.00021.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/17/2024]
Abstract
The magnitude of exercise-induced cardiac troponin (cTn) elevations is dependent on cardiovascular health status, and previous studies have shown that occult coronary atherosclerosis is highly prevalent among amateur athletes. We tested the hypothesis that middle-aged and older athletes with coronary atherosclerosis demonstrate greater cTn elevations following a controlled endurance exercise test compared with healthy peers. We included 59 male athletes from the Measuring Athletes' Risk of Cardiovascular events 2 (MARC-2) study and stratified them as controls [coronary artery calcium score (CACS) = 0, n = 20], high CACS [≥300 Agatston units or ≥75th Multi-Ethnic Study of Atherosclerosis (MESA) percentile, n = 20] or significant stenosis (≥50% in any coronary artery, n = 19). Participants performed a cycling test with incremental workload until volitional exhaustion. Serial high-sensitivity cTn (hs-cTn) T and I concentrations were measured (baseline, after 30-min warm-up, and 0, 30, 60, 120, and 180 min postexercise). There were 58 participants (61 [58-69] yr) who completed the exercise test (76 ± 14 min) with a peak heart rate of 97.7 [94.8-101.8]% of their estimated maximum. Exercise duration and workload did not differ across groups. High-sensitivity cardiac troponin T (Hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI) concentrations significantly increased (1.55 [1.33-2.14]-fold and 2.76 [1.89-3.86]-fold, respectively) over time, but patterns of cTn changes and the incidence of concentrations >99th percentile did not differ across groups. Serial sampling of hs-cTnT and hs-cTnI concentrations during and following an exhaustive endurance exercise test did not reveal differences in exercise-induced cTn release between athletes with versus without coronary atherosclerosis. These findings suggest that a high CACS or a >50% stenosis in any coronary artery does not aggravate exercise-induced cTn release in middle-aged and older athletes.NEW & NOTEWORTHY Exercise-induced cardiac troponin (cTn) release is considered to be dependent on cardiovascular health status. We tested whether athletes with coronary atherosclerosis demonstrate greater exercise-induced cTn release compared with healthy peers. Athletes with coronary atherosclerosis did not differ in cTn release following exercise compared with healthy peers. Our findings suggest that a high CACS or a >50% stenosis in any coronary artery does not aggravate exercise-induced cTn release in middle-aged and older athletes.
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Affiliation(s)
- Sylvan L J E Janssen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Femke de Vries
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alma M A Mingels
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geert Kleinnibbelink
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vincent L Aengevaeren
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Aakre KM, Apple FS, Mills NL, Meex SJR, Collinson PO. Lower Limits for Reporting High-Sensitivity Cardiac Troponin Assays and Impact of Analytical Performance on Patient Misclassification. Clin Chem 2024; 70:497-505. [PMID: 38102065 DOI: 10.1093/clinchem/hvad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Cardiac troponin measurements are indispensable for the diagnosis of myocardial infarction and provide useful information for long-term risk prediction of cardiovascular disease. Accelerated diagnostic pathways prevent unnecessary hospital admission, but require reporting cardiac troponin concentrations at low concentrations that are sometimes below the limit of quantification. Whether analytical imprecision at these concentrations contributes to misclassification of patients is debated. CONTENT The International Federation of Clinical Chemistry Committee on Clinical Application of Cardiac Bio-Markers (IFCC C-CB) provides evidence-based educational statements on analytical and clinical aspects of cardiac biomarkers. This mini-review discusses how the reporting of low concentrations of cardiac troponins impacts on whether or not assays are classified as high-sensitivity and how analytical performance at low concentrations influences the utility of troponins in accelerated diagnostic pathways. Practical suggestions are made for laboratories regarding analytical quality assessment of cardiac troponin results at low cutoffs, with a particular focus on accelerated diagnostic pathways. The review also discusses how future use of cardiac troponins for long-term prediction or management of cardiovascular disease may require improvements in analytical quality. SUMMARY Clinical guidelines recommend using cardiac troponin concentrations as low as the limit of detection of the assay to guide patient care. Laboratories, manufacturers, researchers, and external quality assessment providers should extend analytical performance monitoring of cardiac troponin assays to include the concentration ranges applicable in these pathways.
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Affiliation(s)
- Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology and Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin Healthcare/HCMC, Minneapolis, MN, United States
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Nicolas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Steven J R Meex
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Paul O Collinson
- Department of Clinical Blood Sciences and Cardiology, St.George's University Hospitals NHS Foundation Trust, London, United Kingdom
- St.George's University of London, London, United Kingdom
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8
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Ghekiere O, Herbots L, Peters B, Berg BV, Dresselaers T, Franssen W, Padovani B, Ducreux D, Ferrari E, Nchimi A, Demanez S, De Bosscher R, Willems R, Heidbuchel H, La Gerche A, Claessen G, Bogaert J, Eijnde BO. Exercise-induced myocardial T1 increase and right ventricular dysfunction in recreational cyclists: a CMR study. Eur J Appl Physiol 2023; 123:2107-2117. [PMID: 37480391 PMCID: PMC10492712 DOI: 10.1007/s00421-023-05259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Although cardiac troponin I (cTnI) increase following strenuous exercise has been observed, the development of exercise-induced myocardial edema remains unclear. Cardiac magnetic resonance (CMR) native T1/T2 mapping is sensitive to the pathological increase of myocardial water content. Therefore, we evaluated exercise-induced acute myocardial changes in recreational cyclists by incorporating biomarkers, echocardiography and CMR. METHODS Nineteen male recreational participants (age: 48 ± 5 years) cycled the 'L'étape du tour de France" (EDT) 2021' (175 km, 3600 altimeters). One week before the race, a maximal graded cycling test was conducted to determine individual heart rate (HR) training zones. One day before and 3-6 h post-exercise 3 T CMR and echocardiography were performed to assess myocardial native T1/T2 relaxation times and cardiac function, and blood samples were collected. All participants were asked to cycle 2 h around their anaerobic gas exchange threshold (HR zone 4). RESULTS Eighteen participants completed the EDT stage in 537 ± 58 min, including 154 ± 61 min of cycling time in HR zone 4. Post-race right ventricular (RV) dysfunction with reduced strain and increased volumes (p < 0.05) and borderline significant left ventricular global longitudinal strain reduction (p = 0.05) were observed. Post-exercise cTnI (0.75 ± 5.1 ng/l to 69.9 ± 41.6 ng/l; p < 0.001) and T1 relaxation times (1133 ± 48 ms to 1182 ± 46 ms, p < 0.001) increased significantly with no significant change in T2 (p = 0.474). cTnI release correlated with increase in T1 relaxation time (p = 0.002; r = 0.703), post-race RV dysfunction (p < 0.05; r = 0.562) and longer cycling in HR zone 4 (p < 0.05; r = 0.607). CONCLUSION Strenuous exercise causes early post-race cTnI increase, increased T1 relaxation time and RV dysfunction in recreational cyclists, which showed interdependent correlation. The long-term clinical significance of these changes needs further investigation. TRIAL REGISTRATION NUMBERS AND DATE NCT04940650 06/18/2021. NCT05138003 06/18/2021.
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Affiliation(s)
- Olivier Ghekiere
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium.
- Department of Radiology and Department of Jessa & Science, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.
| | - Lieven Herbots
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Heart Centre, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Benjamin Peters
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Department of Radiology and Department of Jessa & Science, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | | | - Tom Dresselaers
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Franssen
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Nutrition and Movement Sciences; NUTRIM, School for Nutrition and Translation Research Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | | | - Emile Ferrari
- Department of Cardiology, University Hospital Nice, Nice, France
| | - Alain Nchimi
- Department of Radiology, Centre Hospitalier Universitaire Luxembourg, Luxembourg, Luxembourg
| | - Sophie Demanez
- Department of Cardiology, Centre Cardiologique Orban, Liège, Belgium
| | - Ruben De Bosscher
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Andre La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Guido Claessen
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Heart Centre, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Bert O Eijnde
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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9
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Agarwal D, Côté E, O'Sullivan L, Meurs KM, Steiner J. Investigation of the cardiac effects of exercise testing on apparently healthy Boxer dogs. J Vet Intern Med 2023; 37:1667-1678. [PMID: 37578273 PMCID: PMC10472998 DOI: 10.1111/jvim.16830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Holter electrocardiographic monitoring is a cornerstone of diagnostic testing for arrhythmogenic cardiomyopathy (ACM) in Boxer dogs, but physical activity during monitoring is not controlled. In humans, exercise testing (ExT) can identify latent tachyarrhythmias associated with cardiomyopathy, and exercise increases serum cardiac troponin-I concentrations ([hs-cTnI]). These effects have not yet been investigated in Boxer dogs. HYPOTHESIS/OBJECTIVES Subjecting Boxer dogs to brief, moderate-intensity ExT can identify changes in Holter recordings and [hs-cTnI] compared to baseline results. ANIMALS Thirty overtly healthy, client-owned Boxer dogs. METHODS Prospective interventional study. Dogs underwent baseline diagnostic testing including 24-hour Holter monitoring and [hs-cTnI], followed by brief ExT (accompanied, brisk stair-climbing and -descending for <5 minutes). RESULTS Eleven dogs (37%) had >100 premature ventricular complexes (PVCs)/24 hours at baseline (3), ExT (3), or both (5). After ExT, these dogs had more PVCs/24 hours and greater increases in [hs-cTnI] compared to those with ≤100 PVCs/24 hours. Dogs with the striatin mutation had more PVCs/24 hours and a greater increase in [hs-cTnI] after ExT than did dogs without the striatin mutation. CONCLUSIONS AND CLINICAL IMPORTANCE Exercise testing may improve the binary classification of Boxer dogs with or without ACM by increasing the number of PVCs and [hs-cTnI] in affected dogs to a greater degree than in unaffected dogs. This effect also is associated with presence or absence of the striatin mutation. Exercise should be a controlled variable when screening Boxer dogs for ACM.
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Affiliation(s)
- Deepmala Agarwal
- Department of Companion Animals, Atlantic Veterinary CollegeUniversity of Prince Edward Island, 550 University AvenueCharlottetown, Prince Edward Island C1A 4P3Canada
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary CollegeUniversity of Prince Edward Island, 550 University AvenueCharlottetown, Prince Edward Island C1A 4P3Canada
| | - Lynne O'Sullivan
- Department of Companion Animals, Atlantic Veterinary CollegeUniversity of Prince Edward Island, 550 University AvenueCharlottetown, Prince Edward Island C1A 4P3Canada
| | - Kathryn M. Meurs
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State University, 1060 William Moore DriveRaleigh, North Carolina 27607USA
| | - Jörg Steiner
- Gastrointestinal LaboratorySchool of Veterinary Medicine and Biomedical Sciences, TAMU 4474, Texas A&M UniversityCollege Station, Texas 77843‐4474USA
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10
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Erevik CB, Kleiven Ø, Frøysa V, Bjørkavoll-Bergseth M, Chivulescu M, Klæboe LG, Dejgaard L, Auestad B, Skadberg Ø, Melberg T, Urheim S, Haugaa K, Edvardsen T, Ørn S. Myocardial inefficiency is an early indicator of exercise-induced myocardial fatigue. Front Cardiovasc Med 2023; 9:1081664. [PMID: 36712275 PMCID: PMC9874326 DOI: 10.3389/fcvm.2022.1081664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Background The effect of prolonged, high-intensity endurance exercise on myocardial function is unclear. This study aimed to determine the left ventricular (LV) response to increased exercise duration and intensity using novel echocardiographic tools to assess myocardial work and fatigue. Materials and methods LV function was assessed by echocardiography before, immediately, and 24 h after a cardiopulmonary exercise test (CPET) and a 91-km mountain bike leisure race. Cardiac Troponin I (cTnI) was used to assess myocyte stress. Results 59 healthy recreational athletes, 52 (43-59) years of age, 73% males, were included. The race was longer and of higher intensity generating higher cTnI levels compared with the CPET (p < 0.0001): Race/CPET: exercise duration: 230 (210, 245)/43 (40, 45) minutes, mean heart rate: 154 ± 10/132 ± 12 bpm, max cTnI: 77 (37, 128)/12 (7, 23) ng/L. Stroke volume and cardiac output were higher after the race than CPET (p < 0.005). The two exercises did not differ in post-exercise changes in LV ejection fraction (LVEF) or global longitudinal strain (GLS). There was an increase in global wasted work (p = 0.001) following the race and a persistent reduction in global constructive work 24 h after exercise (p = 0.003). Conclusion Increased exercise intensity and duration were associated with increased myocardial wasted work post-exercise, without alterations in LVEF and GLS from baseline values. These findings suggest that markers of myocardial inefficiency may precede reduction in global LV function as markers of myocardial fatigue.
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Affiliation(s)
- Christine Bjørkvik Erevik
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway,*Correspondence: Christine Bjørkvik Erevik,
| | - Øyunn Kleiven
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Vidar Frøysa
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Monica Chivulescu
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Gunnar Klæboe
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Dejgaard
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Skadberg
- Department of Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Tor Melberg
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Stig Urheim
- Department of Cardiology, Bergen University Hospital, Bergen, Norway
| | - Kristina Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stein Ørn
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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11
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Graziano F, Juhasz V, Brunetti G, Cipriani A, Szabo L, Merkely B, Corrado D, D’Ascenzi F, Vago H, Zorzi A. May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review. J Cardiovasc Dev Dis 2022; 9:jcdd9100347. [PMID: 36286299 PMCID: PMC9604467 DOI: 10.3390/jcdd9100347] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
The positive effects of physical activity are countless, not only on the cardiovascular system but on health in general. However, some studies suggest a U-shape relationship between exercise volume and effects on the cardiovascular system. On the basis of this perspective, moderate-dose exercise would be beneficial compared to a sedentary lifestyle, while very high-dose physical activity would paradoxically be detrimental. We reviewed the available evidence on the potential adverse effects of very intense, prolonged exercise on the cardiovascular system, both acute and chronic, in healthy athletes without pre-existing cardiovascular conditions. We found that endurance sports activities may cause reversible electrocardiographic changes, ventricular dysfunction, and troponin elevation with complete recovery within a few days. The theory that repeated bouts of acute stress on the heart may lead to chronic myocardial damage remains to be demonstrated. However, male veteran athletes with a long sports career show an increased prevalence of cardiovascular abnormalities such as electrical conduction delay, atrial fibrillation, myocardial fibrosis, and coronary calcifications compared to non-athletes. It must be underlined that the cause-effect relationship between such abnormalities and the exercise and, most importantly, the prognostic relevance of such findings remains to be established.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Vencel Juhasz
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Liliana Szabo
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Hajnalka Vago
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
- Correspondence: ; Tel.: +39-049-8212322
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12
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Tasca J, Bianchi G, Girardello A, Lucchini A, Cappelli C. Cardiac involvement in athletes infected by SARS COV-2 disease. Sci Sports 2022; 37:167-175. [PMID: 35153372 PMCID: PMC8818378 DOI: 10.1016/j.scispo.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 01/17/2023]
Abstract
Objectives The aim of the present study was to conduct a review of the current literature evaluating the available evidence to date in terms of epidemiology, pathophysiology and clinical presentation of COVID-19 in relation to cardiovascular involvement, with a special focus on the myocarditis model, in the population of athletes (professional and recreational) who are preparing to return to competitions, with the ultimate aim of guaranteeing maximum safety for resuming sports activities. News The COVID-19 pandemic has resulted in the inevitable cancellation of most sports activities, practiced at both a professional and amateur level, in order to minimize the risk of spreading the infection. Since the number of athletes who tested positive was rather high, the potential cardiac involvement in this peculiar population of subjects contracting the disease in a mild (asymptomatic, slightly symptomatic) or moderate form, has recently raised concerns following the observation of cases of recorded myocardial damage, myocarditis, arrhythmias and a first reported case of Sudden Cardiac Death (SCD) in a 27-year-old professional basketball player. Several studies even seem to confirm the possibility of permanent impairment of the cardiorespiratory system following the infection. Medical history, biomarkers, electrocardiographical and cardiac imaging features appear to be crucial in distinguishing cardiovascular alterations related to COVID-19 infection from typical adaptations to exercise related to athletes' heart. Prospects and Projects Clarifications and prospective data based on long-term follow-ups on larger populations of athletes are still needed to exclude the development of myocardial damage capable of negatively affecting prognosis and increasing cardiovascular risk in athletes recovered from COVID-19 in asymptomatic (simple positivity to SARS-COV-2) or in a mild form. Conclusion From a clinical point of view extreme caution is necessary when planning the return to sport (Return To Play-RTP) of athletes recovered from a mild or asymptomatic form of COVID-19: a careful preliminary medical-sports evaluation should be carried out in order to assess the potential development of myocardial damage that would increase their cardiovascular risk.
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13
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Hammarsten O, Ljungqvist P, Redfors B, Wernbom M, Widing H, Lindahl B, Salahuddin S, Sammantar R, Jha S, Ravn-Fischer A, Brink M, Gisslen M. The ratio of cardiac troponin T to troponin I may indicate non-necrotic troponin release among COVID-19 patients. Clin Chim Acta 2022; 527:33-37. [PMID: 34998858 PMCID: PMC8744390 DOI: 10.1016/j.cca.2021.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although cardiac troponin T (cTnT) and troponin I(cTnI) are expressed to similar amount in cardiac tissue, cTnI often reach ten-times higher peak levels compared to cTnT in patients with myocardial necrosis such as in acute myocardial infarction (MI). In contrast, similar levels of cTnT and cTnI are observed in other situations such as stable atrial fibrillation and after strenuous exercise. OBJECTIVE Examine cTnT and cTnI levels in relation to COVID-19 disease and MI. METHODS Clinical and laboratory data from the local hospital from an observational cohort study of 27 patients admitted with COVID-19 and 15 patients with myocardial infarction (MI) that were analyzed with paired cTnT and cTnI measurement during hospital care. RESULTS Levels of cTnI were lower than cTnT in COVID-19 patients (TnI/TnT ratio 0.3, IQR: 0.1-0.6). In contrast, levels of cTnI were 11 times higher compared to cTnT in 15 patients with MI (TnI/TnT ratio 11, IQR: 7-14). The peak cTnI/cTnT ratio among the patients with MI following successful percutaneous intervention were 14 (TnI/TnT ratio 14, IQR: 12-23). The 5 COVID-19 patient samples collected under possible necrotic events had a cTnI/cTnT ratio of 5,5 (IQR: 1,9-8,3). CONCLUSIONS In patients with COVID-19, cTnT is often elevated to higher levels than cTnI in sharp contrast to patients with MI, indicating that the release of cardiac troponin has a different cause in COVID-19 patients.
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Affiliation(s)
- Ola Hammarsten
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Sweden.
| | - Pontus Ljungqvist
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Sweden
| | - Björn Redfors
- Department of emergency medicine, Sahlgrenska Academy at Sahlgrenska University hospital, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg Sweden
| | - Mathias Wernbom
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Hannes Widing
- Region Västra Götaland, Sahlgrenska University Hospital/Östra, Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Sweden
| | - Sabin Salahuddin
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Sweden
| | - Ruwayda Sammantar
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Sweden
| | - Sandeep Jha
- Department of emergency medicine, Sahlgrenska Academy at Sahlgrenska University hospital, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg Sweden
| | - Magnus Brink
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Magnus Gisslen
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Aengevaeren VL, Baggish AL, Chung EH, George K, Kleiven Ø, Mingels AMA, Ørn S, Shave RE, Thompson PD, Eijsvogels TMH. Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance. Circulation 2021; 144:1955-1972. [PMID: 34898243 PMCID: PMC8663527 DOI: 10.1161/circulationaha.121.056208] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Serological assessment of cardiac troponins (cTn) is the gold standard to assess myocardial injury in clinical practice. A greater magnitude of acutely or chronically elevated cTn concentrations is associated with lower event-free survival in patients and the general population. Exercise training is known to improve cardiovascular function and promote longevity, but exercise can produce an acute rise in cTn concentrations, which may exceed the upper reference limit in a substantial number of individuals. Whether exercise-induced cTn elevations are attributable to a physiological or pathological response and if they are clinically relevant has been debated for decades. Thus far, exercise-induced cTn elevations have been viewed as the only benign form of cTn elevations. However, recent studies report intriguing findings that shed new light on the underlying mechanisms and clinical relevance of exercise-induced cTn elevations. We will review the biochemical characteristics of cTn assays, key factors determining the magnitude of postexercise cTn concentrations, the release kinetics, underlying mechanisms causing and contributing to exercise-induced cTn release, and the clinical relevance of exercise-induced cTn elevations. We will also explain the association with cardiac function, correlates with (subclinical) cardiovascular diseases and exercise-induced cTn elevations predictive value for future cardiovascular events. Last, we will provide recommendations for interpretation of these findings and provide direction for future research in this field.
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Affiliation(s)
- Vincent L Aengevaeren
- Radboud Institute for Health Sciences, Departments of Physiology (V.L.A., T.M.H.E.), Radboud University Medical Center, Nijmegen, The Netherlands.,Cardiology (V.L.A.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston (A.L.B.)
| | - Eugene H Chung
- Michigan Medicine, University of Michigan, Ann Arbor (E.H.C.)
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (K.G.)
| | - Øyunn Kleiven
- Cardiology Department, Stavanger University Hospital, Norway (Ø.K., S.Ø.)
| | - Alma M A Mingels
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center Maastricht, The Netherlands (A.M.A.M.)
| | - Stein Ørn
- Cardiology Department, Stavanger University Hospital, Norway (Ø.K., S.Ø.).,Department of Electrical Engineering and Computer Science, University of Stavanger, Norway (S.Ø.)
| | - Rob E Shave
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Vancouver, Canada (R.E.S.)
| | | | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Departments of Physiology (V.L.A., T.M.H.E.), Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Bjørkavoll‐Bergseth M, Erevik CB, Kleiven Ø, Eijsvogels TMH, Skadberg Ø, Frøysa V, Wiktorski T, Auestad B, Edvardsen T, Moberg Aakre K, Ørn S. Determinants of Interindividual Variation in Exercise-Induced Cardiac Troponin I Levels. J Am Heart Assoc 2021; 10:e021710. [PMID: 34459237 PMCID: PMC8649268 DOI: 10.1161/jaha.121.021710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022]
Abstract
Background Postexercise cardiac troponin levels show considerable interindividual variations. This study aimed to identify the major determinants of this postexercise variation in cardiac troponin I (cTnI) following 3 episodes of prolonged high-intensity endurance exercise. Methods and Results Study subjects were recruited among prior participants in a study of recreational cyclists completing a 91-km mountain bike race in either 2013 or 2014 (first race). In 2018, study participants completed a cardiopulmonary exercise test 2 to 3 weeks before renewed participation in the same race (second race). Blood was sampled before and at 3 and 24 hours following all exercises. Blood samples were analyzed using the same Abbot high-sensitivity cTnI STAT assay. Fifty-nine individuals (aged 50±9 years, 13 women) without cardiovascular disease were included. Troponin values were lowest before, highest at 3 hours, and declining at 24 hours. The largest cTnI difference was at 3 hours following exercise between the most (first race) (cTnI: 200 [87-300] ng/L) and the least strenuous exercise (cardiopulmonary exercise test) (cTnI: 12 [7-23] ng/L; P<0.001). The strongest correlation between troponin values at corresponding times was before exercise (r=0.92, P<0.0001). The strongest correlations at 3 hours were between the 2 races (r=0.72, P<0.001) and at 24 hours between the cardiopulmonary exercise test and the second race (r=0.83, P<0.001). Participants with the highest or lowest cTnI levels showed no differences in race performance or baseline echocardiographic parameters. Conclusions The variation in exercise-induced cTnI elevation is largely determined by a unique individual cTnI response that is dependent on the duration of high-intensity exercise and the timing of cTnI sampling. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02166216.
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Affiliation(s)
- Magnus Bjørkavoll‐Bergseth
- Cardiology DepartmentStavanger University HospitalStavangerNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | | | - Øyunn Kleiven
- Cardiology DepartmentStavanger University HospitalStavangerNorway
| | - Thijs M. H. Eijsvogels
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenthe Netherlands
| | - Øyvind Skadberg
- Department of BiochemistryStavanger University HospitalStavangerNorway
| | - Vidar Frøysa
- Cardiology DepartmentStavanger University HospitalStavangerNorway
| | - Tomasz Wiktorski
- Department of Electrical Engineering and Computer ScienceUniversity of StavangerStavangerNorway
| | - Bjørn Auestad
- Department of Mathematics and PhysicsUniversity of StavangerStavangerNorway
- Research DepartmentStavanger University HospitalStavangerNorway
| | - Thor Edvardsen
- Department of CardiologyOslo University HospitalOsloNorway
- Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Kristin Moberg Aakre
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Medical Biochemistry and PharmacologyHaukeland University HospitalBergenNorway
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
| | - Stein Ørn
- Cardiology DepartmentStavanger University HospitalStavangerNorway
- Department of Electrical Engineering and Computer ScienceUniversity of StavangerStavangerNorway
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16
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Hansen MW, Ørn S, Erevik CB, Bjørkavoll-Bergseth MF, Skadberg Ø, Melberg TH, Aakre KM, Kleiven Ø. Regular consumption of cod liver oil is associated with reduced basal and exercise-induced C-reactive protein levels; a prospective observational trial : A NEEDED (The North Sea Race Endurance Exercise Study) 2014 sub-study. J Int Soc Sports Nutr 2021; 18:51. [PMID: 34183020 PMCID: PMC8240263 DOI: 10.1186/s12970-021-00437-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/29/2021] [Indexed: 12/31/2022] Open
Abstract
Background Dietary supplement use among recreational athletes is common, with the intention of reducing inflammation and improving recovery. We aimed to describe the relationship between omega-3 fatty acid supplement use and inflammation induced by strenuous exercise. Methods C-reactive protein (CRP) concentrations were measured in 1002 healthy recreational athletes before and 24 h after a 91-km bicycle race. The use of omega-3 fatty acid supplements was reported in 856 out of 1002 recreational athletes, and the association between supplement use and the exercise-induced CRP response was assessed. Results Two hundred seventy-four subjects reported regular use of omega-3 fatty acid supplements. One hundred seventy-three of these used cod liver oil (CLO). Regular users of omega-3 fatty acid supplements had significantly lower basal and exercise-induced CRP levels as compared to non-users (n = 348, p < 0.001). Compared to non-users, regular users had a 27% (95% confidence interval (CI): 14–40) reduction in Ln CRP response (unadjusted model, p < 0.001) and 16% (95% CI: 5–28, p = 0.006) reduction after adjusting for age, sex, race duration, body mass index, delta creatine kinase, MET hours per week, resting heart rate and higher education. CLO was the primary driver of this response with a 34% (95% CI: 19–49) reduction (unadjusted model, p < 0.001) compared to non-users. Corresponding numbers in the adjusted model were 24% (95% CI: 11–38, p < 0.001). Conclusion Basal CRP levels were reduced, and the exercise-induced CRP response was attenuated in healthy recreational cyclists who used omega-3 fatty acid supplements regularly. This effect was only present in regular users of CLO. Trial registration NCT02166216, registered June 18, 2014 – Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12970-021-00437-1.
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Affiliation(s)
- Mette Wærstad Hansen
- Cardiology Department, Stavanger University Hospital, PO 8400, 4068, Stavanger, Norway
| | - Stein Ørn
- Cardiology Department, Stavanger University Hospital, PO 8400, 4068, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Christine B Erevik
- Cardiology Department, Stavanger University Hospital, PO 8400, 4068, Stavanger, Norway
| | | | - Øyvind Skadberg
- Department of Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Tor H Melberg
- Cardiology Department, Stavanger University Hospital, PO 8400, 4068, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristin M Aakre
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Øyunn Kleiven
- Cardiology Department, Stavanger University Hospital, PO 8400, 4068, Stavanger, Norway.
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17
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Koppen E, Omland T, Larsen AI, Karlsen T, Linke A, Prescott E, Halle M, Dalen H, Delagardelle C, Hole T, van Craenenbroeck EM, Beckers P, Ellingsen Ø, Feiereisen P, Valborgland T, Videm V. Exercise training and high-sensitivity cardiac troponin T in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:2183-2192. [PMID: 33754453 PMCID: PMC8120390 DOI: 10.1002/ehf2.13310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Whether an exercise training intervention is associated with reduction in long-term high-sensitivity cardiac troponin T (hs-cTnT) concentration (a biomarker of subclinical myocardial injury) in patients with heart failure with reduced ejection fraction (HFrEF) is unknown. The aims were to determine (i) the effect of a 12 week endurance exercise training intervention with different training intensities on hs-cTnT in stable patients with HFrEF (left ventricular ejection fraction ≤ 35%) and (ii) associations between hs-cTnT and peak oxygen uptake (VO2peak ). METHODS AND RESULTS In this sub-study of the SMARTEX-HF trial originally including 261 patients from nine European centres, 213 eligible patients were included after withdrawals and appropriate exclusions [19% women, mean age 61.2 years (standard deviation: 11.9)], randomized to high-intensity interval training (HIIT; n = 77), moderate continuous training (MCT; n = 63), or a recommendation of regular exercise (RRE; n = 73). Hs-cTnT measurements and clinical data acquired before (BL) and after a 12 week exercise training intervention (12 weeks) and at 1 year follow-up (1 year) were analysed using multivariable mixed models. Baseline hs-cTnT was above the 99th percentile upper reference limit of 14 ng/L in 35 (48%), 35 (56%), and 49 (64%) patients in the RRE, MCT, and HIIT groups, respectively. Median hs-cTnT was 16 ng/L at BL, 14 ng/L at 12 weeks, and 14 ng/L at 1 year. Hs-cTnT was statistically significantly reduced at 12 weeks in a model adjusted for randomization group, centre and VO2peak , and after further adjustment in the final model that also included age, sex, creatinine concentrations, N-terminal pro-brain natriuretic peptide, smoking, and heart failure treatment. The mean reduction from BL to 12 weeks in the final model was 1.1 ng/L (95% confidence interval: 1.0-1.2 ng/L, P < 0.001), and the reduction was maintained at 1 year with a mean reduction from BL to 1 year of 1.1 ng/L (95% confidence interval: 1.0-1.1 ng/L, P = 0.025). Randomization group was not associated with hs-cTnT at any time point (overall test: P = 0.20, MCT vs. RRE: P = 0.81, HIIT vs. RRE: P = 0.095, interaction time × randomization group: P = 0.88). Independent of time point, higher VO2peak correlated with lower hs-cTnT (mean reduction over all time points: 0.2 ng/L per increasing mL·kg-1 ·min-1 , P = 0.002), without between-group differences (P = 0.19). CONCLUSIONS In patients with stable HFrEF, a 12 week exercise intervention was associated with reduced hs-cTnT in all groups when adjusted for clinical variables. Higher VO2peak correlated with lower hs-cTnT, suggesting a positive long-term effect of increasing VO2peak on subclinical myocardial injury in HFrEF, independent of training programme.
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Affiliation(s)
- Elias Koppen
- Department of Clinical and Molecular MedicineNTNU – Norwegian University of Science and TechnologyTrondheimNorway
| | - Torbjørn Omland
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
- Cardiovascular Research Group, Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Alf Inge Larsen
- Department of CardiologyStavanger University HospitalStavangerNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Trine Karlsen
- Faculty of Nursing and Health SciencesNord UniversityBodøNorway
- Cardiac Exercise Research Group, Department of Circulation and Medical ImagingNTNU – Norwegian University of Science and TechnologyTrondheimNorway
| | - Axel Linke
- Heart Centre DresdenUniversity Hospital at Technical University of DresdenDresdenGermany
| | - Eva Prescott
- Department of CardiologyBispebjerg Hospital, University of CopenhagenCopenhagenDenmark
| | - Martin Halle
- Department of Prevention and Sports MedicineTechnical University of Munich, Klinikum rechts der IsarMunichGermany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
| | - Håvard Dalen
- Cardiac Exercise Research Group, Department of Circulation and Medical ImagingNTNU – Norwegian University of Science and TechnologyTrondheimNorway
- Clinic of CardiologySt. Olavs University HospitalTrondheimNorway
- Department of MedicineLevanger Hospital, Nord‐Trøndelag Hospital TrustLevangerNorway
| | | | - Torstein Hole
- Cardiac Exercise Research Group, Department of Circulation and Medical ImagingNTNU – Norwegian University of Science and TechnologyTrondheimNorway
- Ålesund Hospital, Møre og Romsdal Health TrustÅlesundNorway
| | - Emeline M. van Craenenbroeck
- Department of CardiologyAntwerp University HospitalEdegemBelgium
- Research Group Cardiovascular Diseases, Translational Pathophysiological ResearchUniversity of AntwerpAntwerpBelgium
| | - Paul Beckers
- Department of CardiologyAntwerp University HospitalEdegemBelgium
- Research Group Cardiovascular Diseases, Translational Pathophysiological ResearchUniversity of AntwerpAntwerpBelgium
| | - Øyvind Ellingsen
- Cardiac Exercise Research Group, Department of Circulation and Medical ImagingNTNU – Norwegian University of Science and TechnologyTrondheimNorway
- Clinic of CardiologySt. Olavs University HospitalTrondheimNorway
| | - Patrick Feiereisen
- Department of CardiologyCentre Hospitalier de LuxembourgLuxembourgLuxembourg
| | - Torstein Valborgland
- Department of CardiologyStavanger University HospitalStavangerNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Vibeke Videm
- Department of Clinical and Molecular MedicineNTNU – Norwegian University of Science and TechnologyTrondheimNorway
- Department of Immunology and Transfusion MedicineSt. Olavs University HospitalTrondheimNO‐7006Norway
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18
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Phelan D, Kim JH, Chung EH. Return-to-Play Guidelines for Athletes After COVID-19 Infection-Reply. JAMA Cardiol 2021; 6:479-480. [PMID: 33146679 DOI: 10.1001/jamacardio.2020.5351] [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: 11/14/2022]
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19
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Li F, Hopkins WG, Wang X, Baker JS, Nie J, Qiu J, Quach B, Wang K, Yi L. Kinetics, Moderators and Reference Limits of Exercise-Induced Elevation of Cardiac Troponin T in Athletes: A Systematic Review and Meta-Analysis. Front Physiol 2021; 12:651851. [PMID: 33841187 PMCID: PMC8033011 DOI: 10.3389/fphys.2021.651851] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/01/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Kinetics, moderators and reference limits for exercise-induced cardiac troponin T (cTnT) elevations are still unclear. Methods: A systematic review of published literature was conducted adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies reporting high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after a bout of exercise in athletes were included and analyzed. The final dataset consisted of 62 estimates from 16 bouts in 13 studies of 5-1,002 athletes (1,421 in total). Meta-analysis was performed using general linear mixed modeling and Bayesian inferences about effect magnitudes. Modifying fixed-effect moderators of gender, age, baseline level, exercise duration, intensity and modalities were investigated. Simulation was used to derive 99th percentile with 95% limits of upper reference ranges for hs-cTnT of athletic populations. Results: The mean and upper reference limits of hs-cTnT before exercise were 4.4 and 19 ng.L-1. Clear increases in hs-cTnT ranging from large to very large (factor changes of 2.1-7.5, 90% compatibility limits, ×/÷1.3) were evident from 0.7 through 25 h, peaking at 2.9 h after the midpoint of a 2.5-h bout of running, when the mean and upper reference limit for hs-cTnT were 33 and 390 ng L-1. A four-fold increase in exercise duration produced a large clear increase (2.4, ×/÷1.7) in post-exercise hs-cTnT. Rowing exercise demonstrated an extremely large clear reduction (0.1 ×/÷2.4). Conclusions: The kinetics of cTnT elevation following exercise, the positive effect of exercise duration, the impact of exercise modality and 99th upper reference limits for athletic populations were reasonably well defined by this meta-analysis.
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Affiliation(s)
- Feifei Li
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong, China
| | - Will G. Hopkins
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Xuejing Wang
- Clinical Laboratory, Civil Aviation General Hospital, Beijing, China
| | - Julien S. Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong, China
| | - Jinlei Nie
- School of Health Sciences and Sports, Macao Polytechnic Institute, Macao, China
| | - Junqiang Qiu
- College of Sport Science School, Beijing Sport University, Beijing, China
| | - Binh Quach
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Kun Wang
- College of Physical Education, Hebei Normal University, Shijiazhuang, China
| | - Longyan Yi
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
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20
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Phelan D, Kim JH, Elliott MD, Wasfy MM, Cremer P, Johri AM, Emery MS, Sengupta PP, Sharma S, Martinez MW, La Gerche A. Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement. JACC Cardiovasc Imaging 2020; 13:2635-2652. [PMID: 33303102 PMCID: PMC7598679 DOI: 10.1016/j.jcmg.2020.10.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
As our understanding of the complications of coronavirus disease-2019 (COVID-19) evolve, subclinical cardiac pathology such as myocarditis, pericarditis, and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern. The potential implications of these findings in athletes are significant given the concern that exercise, during the acute phase of viral myocarditis, may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias. Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID-19 in order to permit safe return to play. Cardiac imaging is at the center of these evaluations. This review seeks to evaluate the current evidence regarding COVID-19-associated cardiovascular disease and how multimodality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection. Guidance is provided with diagnostic "red flags" that raise the suspicion of pathology. Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from subclinical cardiac disease. The strengths and limitations of different imaging modalities are discussed and an approach to return to play decision making for athletes post-COVID-19, as informed by multimodality imaging, is provided.
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Affiliation(s)
- Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA.
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory School of Medicine, Atlanta, Georgia, USA
| | - Michael D Elliott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Meagan M Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Cremer
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amer M Johri
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Michael S Emery
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University Hospital, London, United Kingdom
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Morristown Medical Center, Atlantic Health, Morristown, New Jersey, USA
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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21
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Skranes JB, Kleiven Ø, Aakre KM, Skadberg Ø, Melberg TH, Omland T, Ørn S. High-Sensitivity Cardiac Troponin I and T Response Following Strenuous Activity is Attenuated by Smokeless Tobacco: NEEDED (North Sea Race Endurance Exercise Study) 2014. J Am Heart Assoc 2020; 9:e017363. [PMID: 32930023 PMCID: PMC7792397 DOI: 10.1161/jaha.120.017363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Use of snus, a smokeless tobacco product, is increasing in Scandinavia. Strenuous physical activity is associated with an acute increase in high‐sensitivity cardiac troponin (swhs‐cTn) concentrations. Current smoking is associated with lower hs‐cTn, but whether this also holds true for smokeless tobacco and whether tobacco affects the hs‐cTn response to exercise remain unknown. Methods and Results We measured hs‐cTnI and hs‐cTnT concentrations in 914 recreational athletes before and 3 and 24 hours after a 91‐km bicycle race. Self‐reported snus tobacco habits were reported as noncurrent (n=796) and current (n=118). The association between snus use and change in log‐transformed hs‐cTnI and hs‐cTnT concentrations (ie, the differences between concentrations at baseline and 3 hours and 24 hours ) were assessed by multivariable linear regression analysis. Concentrations of hs‐cTn at baseline were lower in current than in noncurrent snus users (hs‐cTnI median, 1.7 ng/L; Q1 to Q3: 1.6–2.3 versus 2.0 ng/L; Q1 to Q3: 1.6–3.2 [P=0.020]; and hs‐cTnT: median, 2.9 ng/L, Q1 to Q3: 2.9–3.5 versus 2.9 ng/L, Q1 to Q3: 2.9–4.3 [P=0.021]). In fully adjusted multivariable models, use of snus was associated with lower change in hs‐cTn concentrations from baseline to 3 hours (hs‐cTnI: −29% [P=0.002], hs‐cTnT: −18% [P=0.010]) and 24 hours (hscTnI: −30% [P=0.010], hs‐cTnT −19%, [P=0.013]). Conclusions Resting hs‐cTn concentrations are lower and the exercise‐induced cardiac troponin response is attenuated in current users of smokeless tobacco compared with nonusers. Further insight into the pathophysiological processes underlying the attenuated cardiac troponin response to exercise in tobacco users is needed. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02166216.
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Affiliation(s)
- Julia Brox Skranes
- Department of Cardiology Akershus University Hospital Lørenskog Norway.,Institute of Clinical Medicine University of Oslo Norway
| | - Øyunn Kleiven
- Cardiology Department Stavanger University Hospital Stavanger Norway
| | - Kristin Moberg Aakre
- Department of Medical Biochemistry and Pharmacology Haukeland University Hospital Bergen Norway.,Department of Clinical Science University of Bergen Norway
| | - Øyvind Skadberg
- Department of Biochemistry Stavanger University Hospital Stavanger Norway
| | - Tor H Melberg
- Cardiology Department Stavanger University Hospital Stavanger Norway
| | - Torbjørn Omland
- Department of Cardiology Akershus University Hospital Lørenskog Norway.,Institute of Clinical Medicine University of Oslo Norway
| | - Stein Ørn
- Cardiology Department Stavanger University Hospital Stavanger Norway.,Department of Electrical Engineering and Computer Science University of Stavanger Norway
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22
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Martínez-Navarro I, Sanchez-Gómez JM, Aparicio I, Priego-Quesada JI, Pérez-Soriano P, Collado E, Hernando B, Hernando C. Effect of mountain ultramarathon distance competition on biochemical variables, respiratory and lower-limb fatigue. PLoS One 2020; 15:e0238846. [PMID: 32915883 PMCID: PMC7485829 DOI: 10.1371/journal.pone.0238846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/25/2020] [Indexed: 12/26/2022] Open
Abstract
The study aimed at assessing the acute physiological effects of running a 65-km vs a 107-km mountain ultramarathon. Nineteen athletes (15 males and 4 females) from the shorter race and forty three athletes (26 males and 17 females) from the longer race were enrolled. Body weight, respiratory and lower limb strength were assessed before and after the race. Blood samples were obtained before, after and 24-h post-race. Body weight loss did not differ between races. A decrease in squat jump height (p<0.01; d = 1.4), forced vital capacity (p<0.01; d = 0.5), forced expiratory volume in 1 s (p<0.01; d = 0.6), peak inspiratory flow (p<0.01; d = 0.6) and maximal inspiratory pressure (p<0.01; d = 0.8) was observed after the longer race; while, after the shorter race only maximal inspiratory pressure declined (p<0.01; d = 0.5). Greater post-race concentrations of creatine kinase (p<0.01; d = 0.9) and C-reactive protein (p<0.01; d = 2.3) were observed following the longer race, while high-sensitivity cardiac troponin was higher after the shorter race (p<0.01; d = 0.3). Sodium decreased post-competition only after the shorter race (p = 0.02; d = 0.6), while creatinine increased only following the longer race (p<0.01; d = 1.5). In both groups, glomerular filtration rate declined at post-race (longer race: p<0.01, d = 2.1; shorter race: p = 0.01, d = 1.4) and returned to baseline values at 24 h post-race. In summary, expiratory and lower-limb fatigue, and muscle damage and inflammatory response were greater following the longer race; while a higher release of cardiac troponins was observed after the shorter race. The alteration and restoration of renal function was similar after either race.
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Affiliation(s)
- Ignacio Martínez-Navarro
- Physical Education and Sports Department, University of Valencia, Valencia, Spain
- Sports Health Unit, Vithas 9 de Octubre Hospital, Valencia, Spain
| | - Juan Miguel Sanchez-Gómez
- Sports Health Unit, Vithas 9 de Octubre Hospital, Valencia, Spain
- University Clinical Hospital of Valencia, Valencia, Spain
| | - Inma Aparicio
- Research Group in Sports Biomechanics (GIBD), Physical Education and Sports Department, University of Valencia, Valencia, Spain
- AITEX (Textil Research Institute), Alcoy, Spain
| | - Jose Ignacio Priego-Quesada
- Research Group in Sports Biomechanics (GIBD), Physical Education and Sports Department, University of Valencia, Valencia, Spain
| | - Pedro Pérez-Soriano
- Research Group in Sports Biomechanics (GIBD), Physical Education and Sports Department, University of Valencia, Valencia, Spain
| | - Eladio Collado
- Faculty of Health Sciences, Jaume I University, Castellon, Spain
| | | | - Carlos Hernando
- Sport Service, Jaume I University, Castellon, Spain
- Department of Education and Specific Didactics, Jaume I University, Castellon, Spain
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23
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Martínez-Navarro I, Sánchez-Gómez J, Sanmiguel D, Collado E, Hernando B, Panizo N, Hernando C. Immediate and 24-h post-marathon cardiac troponin T is associated with relative exercise intensity. Eur J Appl Physiol 2020; 120:1723-1731. [PMID: 32468283 DOI: 10.1007/s00421-020-04403-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We aimed at exploring whether cardiopulmonary fitness, echocardiographic measures and relative exercise intensity were associated with high-sensitivity cardiac troponin T (hs-TNT) rise and normalization following a marathon. METHODS Nighty-eight participants (83 men, 15 women; 38.72 ± 3.63 years) were subjected to echocardiographic assessment and a cardiopulmonary exercise test (CPET) before the race. hs-TNT was measured before, immediately after and at 24, 48, 96, 144 and 192 h post-race. Speed and mean heart rate (HR) during the race were relativized to CPET values: peak speed (%VVMAX), peak HR (HR%MAX), speed and HR at the second ventilatory threshold (HR%VT2 and %VVT2). RESULTS Hs-TNT increased from pre- to post-race (5.74 ± 5.29 vs. 50.4 ± 57.04 ng/L; p < 0.001), seeing values above the Upper Reference Limit (URL) in 95% of the participants. At 24 h post-race, 39% of the runners still exceeded the URL (High hs-TNT group). hs-TNT rise was correlated with marathon speed %VVT2 (r = 0.22; p = 0.042), mean HR%VT2 (r = 0.30; p = 0.007), and mean HR%MAX (r = 0.32; p = 0.004). Moreover, the High hs-TNT group performed the marathon at a higher Speed %VVT2 (88.21 ± 6.53 vs. 83.49 ± 6.54%; p = 0.002) and Speed %VVMAX (72 ± 4.25 vs. 69.40 ± 5.53%; p = 0.009). hs-TNT showed no significant associations with cardiopulmonary fitness and echocardiographic measures, except for a slight correlation with left ventricular end systolic diameter (r = 0.26; p = 0.018). CONCLUSION Post-race hs-TNT was above the URL in barely all runners. Magnitude of hs-TNT rise was correlated with exercise mean HR; whereas, its normalization kept relationship with marathon relative speed.
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Affiliation(s)
- Ignacio Martínez-Navarro
- Physical Education and Sports Department, Faculty of Physical Activity and Sport Sciences, University of Valencia, C/Gascó Oliag 3, 46010, Valencia, Spain. .,Sports Health Unit, Vithas 9 de Octubre Hospital, Valencia, Spain.
| | - J Sánchez-Gómez
- Sports Health Unit, Vithas 9 de Octubre Hospital, Valencia, Spain.,Universitary Clinical Hospital of Valencia, Valencia, Spain
| | - D Sanmiguel
- Sports Health Unit, Vithas 9 de Octubre Hospital, Valencia, Spain.,General Hospital of Valencia, Valencia, Spain
| | - E Collado
- Faculty of Health Sciences, Jaume I University, Castellón de la Plana, Castellon, Spain
| | - B Hernando
- Department of Medicine, Jaume I University, Castellón de la Plana, Castellon, Spain
| | - N Panizo
- Faculty of Health Sciences, Jaume I University, Castellón de la Plana, Castellon, Spain.,Universitary Doctor Peset Hospital of Valencia, Valencia, Spain
| | - C Hernando
- Sport Service, Jaume I University, Castellón de la Plana, Castellon, Spain.,Department of Education and Specific Didactics, Jaume I University, Castellón de la Plana, Castellon, Spain
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24
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Lippi G, Sanchis-Gomar F. Cardiac troponin release during and after endurance exercise: epidemiologic health implications. Future Cardiol 2020; 16:147-150. [PMID: 32125185 DOI: 10.2217/fca-2019-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Giuseppe Lippi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia & INCLIVA Biomedical Research Institute, Valencia, Spain
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25
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Kleiven Ø, Bjørkavoll-Bergseth MF, Omland T, Aakre KM, Frøysa V, Erevik CB, Greve OJ, Melberg TH, Auestad B, Skadberg Ø, Edvardsen T, Ørn S. Endurance exercise training volume is not associated with progression of coronary artery calcification. Scand J Med Sci Sports 2020; 30:1024-1032. [PMID: 32100340 DOI: 10.1111/sms.13643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/18/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent cross-sectional studies have suggested a dose-dependent relationship between lifelong exposure to physical activity and the burden of calcified coronary artery disease (CAD). No longitudinal studies have addressed this concern. HYPOTHESIS Exercise volume is associated with progression of coronary artery calcium (CAC), defined as ≥10 units increase in CAC score. METHODS Sixty-one recreational athletes who were assessed by coronary computed tomography angiography (CCTA) as part of the NEEDED 2013/14 study were re-assessed 4-5 years later, in 2018. RESULTS Subjects were 45.9 ± 9.6 years old at inclusion, and 46 (74%) were male. Between 2013 and 2018, the participants reported median 5 (range: 0-20, 25th-75th percentile: 4-6) hours of high-intensity exercise per week. None of the included subjects smoked during follow-up. At inclusion, 21 (33%) participants had coronary artery calcifications. On follow-up CCTA in 2018, 15 (25%) subjects had progressive coronary calcification (≥10 Agatston units increase in CAC). These subjects were older (53 ± 9 vs 44 ± 9 years old, P = .002) and had higher levels of low-density lipoprotein at baseline (3.5 (2.9-4.3) vs 2.9 (2.3-3.5) mmol/L, P = .031) as compared to subjects with stable condition. No relationship was found between hours of endurance training per week and progression of coronary artery calcification. In multiple regression analysis, age and baseline CAC were the only significant predictors of progressive CAC. CONCLUSION No relationship between exercise training volume and the progression of coronary artery calcification was found in this longitudinal study of middle-aged recreational athletes.
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Affiliation(s)
- Øyunn Kleiven
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Torbjørn Omland
- Department of Medicine, Akershus University Hospital, Lorenskog, Norway.,University of Oslo, Oslo, Norway
| | - Kristin M Aakre
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Vidar Frøysa
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway
| | | | - Ole J Greve
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Tor H Melberg
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Auestad
- Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Øyvind Skadberg
- Department of Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Thor Edvardsen
- University of Oslo, Oslo, Norway.,Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stein Ørn
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
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Bjørkavoll-Bergseth M, Kleiven Ø, Auestad B, Eftestøl T, Oskal K, Nygård M, Skadberg Ø, Aakre KM, Melberg T, Gjesdal K, Ørn S. Duration of Elevated Heart Rate Is an Important Predictor of Exercise-Induced Troponin Elevation. J Am Heart Assoc 2020; 9:e014408. [PMID: 32065043 PMCID: PMC7070191 DOI: 10.1161/jaha.119.014408] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The precise mechanisms causing cardiac troponin (cTn) increase after exercise remain to be determined. The aim of this study was to investigate the impact of heart rate (HR) on exercise-induced cTn increase by using sports watch data from a large bicycle competition. Methods and Results Participants were recruited from NEEDED (North Sea Race Endurance Exercise Study). All completed a 91-km recreational mountain bike race (North Sea Race). Clinical status, ECG, blood pressure, and blood samples were obtained 24 hours before and 3 and 24 hours after the race. Participants (n=177) were, on average, 44 years old; 31 (18%) were women. Both cTnI and cTnT increased in all individuals, reaching the highest level (of the 3 time points assessed) at 3 hours after the race (P<0.001). In multiple regression models, the duration of exercise with an HR >150 beats per minute was a significant predictor of both cTnI and cTnT, at both 3 and 24 hours after exercise. Neither mean HR nor mean HR in percentage of maximum HR was a significant predictor of the cTn response at 3 and 24 hours after exercise. Conclusions The duration of elevated HR is an important predictor of physiological exercise-induced cTn elevation. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02166216.
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Affiliation(s)
- Magnus Bjørkavoll-Bergseth
- Department of Cardiology Stavanger University Hospital Stavanger Norway.,Department of Clinical Science University of Bergen Norway
| | - Øyunn Kleiven
- Department of Cardiology Stavanger University Hospital Stavanger Norway
| | - Bjørn Auestad
- Department of Research Stavanger University Hospital Stavanger Norway.,Department of Mathematics and Physics University of Stavanger Norway
| | - Trygve Eftestøl
- Department of Electrical Engineering and Computer Science University of Stavanger Norway
| | - Kay Oskal
- Department of Electrical Engineering and Computer Science University of Stavanger Norway
| | - Martin Nygård
- Department of Electrical Engineering and Computer Science University of Stavanger Norway
| | - Øyvind Skadberg
- Department of Clinical Biochemistry Stavanger University Hospital Stavanger Norway
| | - Kristin Moberg Aakre
- Department of Medical Biochemistry and Pharmacology Haukeland University Hospital Bergen Norway.,Department of Clinical Science University of Bergen Norway
| | - Tor Melberg
- Department of Cardiology Stavanger University Hospital Stavanger Norway
| | - Knut Gjesdal
- Department of Cardiology Oslo University Hospital Ullevål, and Institute of Clinical Medicine Oslo University Oslo Norway
| | - Stein Ørn
- Department of Cardiology Stavanger University Hospital Stavanger Norway.,Department of Electrical Engineering and Computer Science University of Stavanger Norway
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Sanchis-Gomar F, Perez-Quilis C, Lippi G. Time-dependent results in troponin exercise-induced fluctuations. Int J Cardiol 2019; 293:258. [PMID: 31447039 DOI: 10.1016/j.ijcard.2019.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/22/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, School of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.
| | - Carme Perez-Quilis
- Department of Physiology, School of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Affiliation(s)
- Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Oslo, Norway (T.O.).,Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Norway (T.O.)
| | - Kristin Moberg Aakre
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway (K.M.A.).,Department of Clinical Science, University of Bergen, Norway (K.M.A.)
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Brzezinski RY, Milwidsky A, Shenhar-Tsarfaty S. Exercise-induced cardiac troponin in the era of high sensitivity assays: What makes our heart sweat? Int J Cardiol 2019; 288:19-21. [PMID: 30955876 DOI: 10.1016/j.ijcard.2019.03.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Rafael Y Brzezinski
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neufeld Cardiac Research Institute, Sackler Faculty of Medicine, Tel Aviv University, Israel; Tamman Cardiovascular Research Institute, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel.
| | - Assi Milwidsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Kleiven Ø, Omland T, Skadberg Ø, Melberg TH, Bjørkavoll-Bergseth MF, Auestad B, Bergseth R, Greve OJ, Aakre KM, Ørn S. Occult obstructive coronary artery disease is associated with prolonged cardiac troponin elevation following strenuous exercise. Eur J Prev Cardiol 2019; 27:1212-1221. [DOI: 10.1177/2047487319852808] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Sudden cardiac death among middle-aged recreational athletes is predominantly due to myocardial ischaemia. This study examined whether measuring cardiac troponin I and T (cTnI and cTnT) after strenuous exercise could identify occult obstructive coronary artery disease. Design Prospective observational study. Methods Subjects were recruited from 1002 asymptomatic recreational cyclists completing a 91-km mountain bike race (North Sea Race Endurance Exercise Study). No subject had known cardiovascular disease or took cardiovascular medication. Blood samples were collected within 24 h before and 3 h and 24 h after the race. Coronary computed tomography angiography was performed in 80 participants with the highest post-exercise cTnI and in 40 reference subjects with moderately elevated cTnI values. Results Study subjects ( N = 120) were 45 (36–52) years old and 74% were male. There were similar demographics in the High-cTnI group and the Reference group. The cTn concentrations were highest at 3 h post-race: cTnI, 224 (125–304) ng/L; cTnT, 89 (55–124) ng/L. Nine subjects had obstructive coronary artery disease on coronary computed tomography angiography, eight of whom were High-cTnI responders. Two subjects had myocardial bridging, both High-cTnI responders. Troponin concentrations at 24 h post-race were higher in subjects with obstructive coronary artery disease than in the rest of the cohort ( n = 109): cTnI, 151 (72–233) ng/L vs. 24 (19–82) ng/L, p = 0.005; cTnT, 39 (25–55) ng/L vs. 20 (14–31) ng/L, p = 0.002. The areas under the receiver operating characteristic curves for predicting obstructive coronary artery disease were 0.79, p = 0.005 (cTnI) and 0.82, p = 0.002 (cTnT). Conclusion In subjects with occult obstructive coronary artery disease there was a prolonged elevation of cTn following strenuous exercise.
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Affiliation(s)
- Øyunn Kleiven
- Cardiology Department, Stavanger University Hospital, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, and University of Oslo, Oslo, Norway
| | - Øyvind Skadberg
- Department of Biochemistry, Stavanger University Hospital, Norway
| | - Tor H Melberg
- Cardiology Department, Stavanger University Hospital, Norway
| | | | - Bjørn Auestad
- Department of Research, Stavanger University Hospital, Norway
- Department of Mathematics and Physics, University of Stavanger, Norway
| | | | - Ole J Greve
- Department of Radiology, Stavanger University Hospital, Norway
| | - Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Stein Ørn
- Cardiology Department, Stavanger University Hospital, Norway
- Department of Electrical Engineering and Computer Science, University of Stavanger, Norway
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