Individual responses in biomarkers of health after marathon and half-marathon running: is age a factor in troponin changes?

The current paradigm of cardiac troponin increase among athletes

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.

Kinetics of Cardiac Remodeling and Fibrosis Biomarkers During an Extreme Mountain Ultramarathon

Objectives

The effects of ultra-distance on cardiac remodeling and fibrosis are unclear. Moreover, there are no data reporting the kinetics of cardiac alterations throughout the event and during recovery. Our aim was to investigate the kinetics of biological markers including new cardiac fibrosis biomarkers suppression of tumorigenicity 2 (ST2) and galectin-3 (Gal-3) during and after an extreme mountain ultramarathon.

Methods

Fifty experienced runners participating in one of the most challenging mountain ultramarathons (330 km, D+ 25,000 m) were enrolled in our study. Blood samples were collected at four time points: before (Pre-), at 148 km (Mid-), at the finish line (Post-), and 3 days after the recovery period (Recov-).

Results

The cardiac fibrosis biomarkers (ST2 and Gal-3) increased from Pre- to Mid-. During the second half, ST2 remained higher than pre-values as opposed to Gal-3. Necrosis, ischemia, and myocyte injury biomarkers increased until Mid- then decreased but remained higher at Recov- than Pre-values. Oxidative stress appeared at Mid-. Lipid peroxides remained higher at Recov- compared to Pre-. The maximal value in most of these biomarkers was observed at Mid- and not at Post-.

Conclusions

The present study supports biphasic kinetics of cardiac fibrosis biomarkers, with a relative recovery during the second half of the event that seems specific to this extreme event. Overall, performing at such an extreme ultramarathon seems less deleterious for the heart than shorter events.

Associations between cardiac troponin I and cardiovascular parameters after 12-week endurance training in young moderately trained amateur athletes

Background

Previous studies were conducted only on elite athletes, and they investigate acute training responses of cardiac troponin I (CTnI). However, cardiac troponin was found to be elevated in young and inexperienced athletes than adults, and immature myocardium is more susceptible to injury, which needs further consideration.

Aim

Therefore, we aimed to observe the association between CTnI and cardiovascular parameters in response to chronic endurance training adaptation in young athletes.

Methods

Fifteen participants aged (19.5±1.3) years were selected and placed in endurance running at 70%–80% HRmax intensity for 35 min per training for the first week and additional 2 min each week from the second to the last week for 12 weeks. Serum cardiac troponin and cardiovascular parameters were assessed at pre-training and after 12 weeks of training.

Result

We find a significant CTnI level (p<0.05) and it is positively correlated with systolic blood pressure (BP) (r=0.425). Moreover, CTnI was statistically significant (p<0.01) and positively associated with mean arterial pressure (r=0.516) with a moderate correlation. Besides, CTnI showed a significant (p<0.001) and positive relationship with resting heart rate (r=0.605) and a moderate correlation. We did not find a significant relationship between CTnI and diastolic BP in response to endurance training adaptation.

Conclusion

In conclusion, serum CTnI was significantly and positively associated with cardiovascular parameters in young amateur athletes in response to 12-week endurance training adaptation.

Diastolic Function and Biomarkers of Long-Distance Walking Participants

BACKGROUND

The effects of long-distance walking on the cardiovascular system have been little studied.

OBJECTIVES

The general objective of this study was to verify these effects on the behavior of diastolic function and the cardiac biomarkers CK-MB (mass), troponin T, and NT-proBNP, in amateur athletes.

METHOD

This longitudinal study, conducted in 2015, evaluated participants during the following 5 stages: E0 (baseline) before starting the trajectory and the others, E1, E2, E3, and E4, at the end of each day, totaling 244.7 km. At all stages, the biomarkers NT-proBNP, CK-MB (mass), and troponin T were measured. Echocardiogram was performed to analyze the E, A and E' waves. P < 0.05 was adopted as significant.

RESULTS

The study evaluated 25 participants, with an average age of 46 ± 10.5 years and body mass index of 20.2 ± 2.3 kg/m2. Increased values were found for NT-proBNP from E0 to E1, E2, E3, and E4 (p < 0.001), CK-MB (mass) from E0 to E2 (p < 0.001), and E' wave from E0 to E1, E2, E3, and E4 (p < 0.001). Positive correlations were identified between the following: CK-MB (mass) and troponin T (E1: r = 0.524, p = 0.010; E4: r = 0.413, p = 0.044); CK-MB (mass) and NT-proBNP (E4: r = 0.539, p = 0.006); and E/A and E' (E0: r = 0.603, p < 0.001; E1: r = 0.639, p < 0.001; E4: r = 0.593, p = 0.002). A negative correlation was found between CK-MB (mass) and E/A (E1: r = -0.428, p = 0.041).

CONCLUSION

The effects of intense, prolonged, and interspersed physical activity were verified based on significant variations in the behavior of CK-MB (mass), NT-proBNP, and the E' wave. Notwithstanding the alterations found, there were no criteria suggestive of myocardial damage.

Non-steroidal anti-inflammatory drugs increase urinary neutrophil gelatinase-associated lipocalin in recreational runners

Objectives

To study the effects of running with/without the use of pain killers on urinary neutrophil gelatinase‐associated lipocalin (uNGAL) and other parameters of kidney function in recreational runners.

Methods

Participants of the 10‐ and 21.1‐km Weir Venloop race were enrolled and their urine samples collected before and after the run. Urine dipstick and other conventional tests used to assess kidney function were performed. The presence of ibuprofen, diclofenac, naproxen, and/or paracetamol was assessed by LC‐MS/MS. uNGAL was measured with a two‐step chemiluminescent immunoassay.

Results

NSAIDs/analgesics were detected in urine of 5 (14.4%) 10‐km runners and 13 (28.9%) 21.1‐km runners. Only half‐marathon participants showed significant increases in uNGAL (pre: 11.7 [7.1‐34.3] ng/mL; post: 33.4 [17.4‐50.4] ng/mL; P = .0038). There was a significant effect of NSAID/analgesic use on uNGAL increase (F_{2, 76} = 4.210, P = .004). Post hoc tests revealed that uNGAL increased significantly in runners who tested positive for ibuprofen/naproxen compared to runners who did not use any medications (P = .045) or those who tested positive for paracetamol (P = .033). Running distance had a significant influence on the increase in uNGAL (F_{1, 53} = 4.741, P < .05), specific gravity (F_{1, 60} = 9.231, P < .01), urinary creatinine (F_{1, 61} = 10.574, P < .01), albumin (F_{1, 59} = 4.888, P < .05), and development of hematuria (χ²(4) = 18.44, P = .001).

Conclusions

Running distance and use of ibuprofen/naproxen were identified as risk factors for uNGAL increase in recreational runners.

Serum Calprotectin, a Marker of Neutrophil Activation, and Other Mediators of Inflammation in Response to Various Types of Extreme Physical Exertion in Healthy Volunteers

Purpose

While extreme physical exertion is known to induce changes in the status of inflammation comparisons of the responses for various mediators of inflammation after acute bouts of high-intensity exercise have been limited.

Subjects and Methods

We examined the responses in serum levels of novel inflammatory proteins, calprotectin, suPAR, CD163, and pro- and anti-inflammatory cytokines in 12 physically active volunteers (10 men, 2 women, mean age 37±14 years) before and after completing various types of extreme physical exertion (marathon run, half-marathon run or 24-h cross-country skiing). For comparisons, the levels of the biomarkers were also measured at rest in 30 healthy controls (25 men, 5 women, mean age 42 ± 12 years) with low or sedentary activity.

Results

Extreme physical exertion induced significant increases in serum calprotectin (p < 0.0005), suPAR (p < 0.01), CD163 (p < 0.05), IL-6 (p < 0.0005), IL-8 (p < 0.01) and IL-10 (p < 0.0005) (pre- vs 3h-post-exercise). These responses were found to normalize within 48 hours. While the increases in blood leukocytes were of similar magnitude following the different types of exercise, markedly more pronounced responses occurred in serum TNF-α (p < 0.01), IL-8 (p < 0.01) and CD163 (p < 0.05) in those with more intense activity. In 3-h post-exercise samples significant correlations were observed between serum calprotectin and IL-6 (r_s = 0.720, p < 0.01), IL-10 (r_s = 0.615, p < 0.05), TNF-α (r_s = 0.594, p < 0.05), suPAR (r_s = 0.587, p < 0.05) and blood leukocytes (r_s = 0.762, p < 0.01).

Conclusion

The present results suggest distinct exercise-intensity dependent changes in mediators of inflammation (including calprotectin, suPAR and CD163) following extreme physical exertion. Our findings indicate that there is a major reversible impact of high-intensity physical exertion on the status of inflammation.

Serum, erythrocyte and urinary concentrations of iron, copper, selenium and zinc do not change during an incremental test to exhaustion in either normothermic or hyperthermic conditions

AIM

The aim of this study was to evaluate the effect of the performance of an incremental exercise test until exhaustion in normothermic and hyperthermic conditions on serum, erythrocyte and urine concentrations of Iron (Fe), Copper (Cu), Selenium (Se) and Zinc (Zn).

METHODS

Nineteen adult males (age: 22.58 ± 1.06 years) performed two maximum incremental exercise tests on a cycloergometer in normothermia (22 ± 2 °C) and hyperthermia (42±2 °C) separated by 48 h. Urine, serum and erythrocyte samples were collected before and after each test.

RESULTS

Serum Se (p < 0.01) and Cu (p < 0.05) levels were altered after each test, but the significance disappeared with the correction for haematocrit. The rest of the values did not undergo alterations in either condition.

CONCLUSIONS

It seems that a higher stimulus is necessary to obtain changes in these minerals. The study reveals the need to correct serum concentrations concerning possible changes in these volumes after an acute effort.

Pacing During and Physiological Response After a 12-Hour Ultra-Marathon in a 95-Year-Old Male Runner

In recent years, outstanding performances of elderly people up to 100 years have been reported. In this case study, pacing during and recovery after a 12-h ultra-marathon were described for a 95-year old runner. The athlete achieved a total distance of 52.987 km. Pacing followed a parabolic pattern (U-shaped), where the speed decreased till the middle of the race and then increased. However, no end spurt was observed. A large main effect of lap quartile on speed was observed, where the second quartile was slower than the first quartile and forth. The smallest variability was shown in the first quartile and the largest in the second quartile. During recovery, erythrocytes, hemoglobin and hematocrit increased whereas thrombocytes and leucocytes decreased. CRP, GOT, GPT, y-GT, CK, and LDH were increased post-race and decreased to reference range during recovery. Also, creatinine and urea decreased during recovery. Creatinine clearance increased during recovery. Sodium increased during recovery and remained constantly within the reference range. During recovery body fat and visceral fat mass decreased, whereas body water and lean body mass increased. In summary, a 95-year-old man was able to run during 12 h using a U-shaped pacing and achieving a total distance of nearly 53 km. Increased selected hematological and biochemical parameters returned to pre-race values within a recovery phase of 5 days.

Clinical use of submaximal treadmill exercise testing and assessments of cardiac biomarkers NT-proBNP and cTnI in dogs with presymptomatic mitral regurgitation

Exercise intolerance is the first symptom of heart disease. Yet an objective and standardised method in canine cardiology to assess exercise capacity in a clinical setting is lacking. In contrast, exercise testing is a powerful diagnostic tool in humans, providing valuable information on prognosis and impact of therapeutic intervention. To investigate whether an exercise test reveals differences between dogs with early stage mitral regurgitation (MR) and dogs without cardiac disease, 12 healthy beagles (healthy group, HG) and 12 dogs with presymptomatic MR (CHIEF B1 / B2, patient group, PG) underwent a six-stage submaximal exercise test (ET) on a motorised treadmill. They trotted in their individual comfort speed for three minutes per stage, first without incline, afterwards increasing it by 4% for every subsequent stage. Blood samples were taken at rest and during two 3-minute breaks in the course of the test. Further samples were taken after the completion of the exercise test and again after a 3-hour recovery period. Measured parameters included heart rate, lactate and the cardiac biomarkers N-terminal pro-B-Type natriuretic peptide and cardiac Troponin I. The test was performed again under the same conditions in the same dogs three weeks after the first trial to evaluate individual repeatability. Cardiac biomarkers increased significantly in both HG and PG in the course of the test. The increase was more pronounced in CHIEF B1 / B2 dogs than in the HG. N-terminal pro-B-Type natriuretic peptide increased from 435 ± 195 to 523 ± 239 pmol/L (HG) and from 690 to 815 pmol/L (PG). cTnI increased from 0.020 to 0.024 ng/mL (HG) and from 0.06 to 0.08 ng/ml (PG). The present study provides a method to assess exercise-induced changes in cardiac biomarkers under clinical conditions. The increase of NT-proBNP and cTnI is more pronounced in dogs with early-stage MR than in healthy dogs. Results indicate that measuring the parameters before and after exercise is adequate and taking blood samples between the different stages of the ET does not provide additional information. Also, stress echocardiography was inconclusive. It can be concluded that exercise testing, especially in combination with measuring cardiac biomarkers, could be a helpful diagnostic tool in canine cardiology.

Post marathon cardiac troponin T is associated with relative exercise intensity

OBJECTIVES

This study aimed to investigate whether measures of cardiopulmonary fitness and relative exercise intensity were associated with high sensitivity cardiac troponin T (cTnT) rise after a road marathon.

METHODS

Fifty-two marathon runners (age 39±11 years, body mass 76.2±12.9kg, height 1.74±0.09m) attended the laboratory between 2 and 3 weeks prior to attempting the Brighton Marathon, UK. Running economy at 10kmh^-1 (RE10) and race pace (RERP), ventilatory threshold (VT) and VO₂max tests were completed. CTnT was measured within 48h prior to the marathon and within 10min of completing the marathon, using a high sensitivity assay. Heart rates (HR) were recorded throughout the marathon.

RESULTS

Runners demonstrated a significant increase in cTnT over the marathon (pre-race 5.60±3.27ngL^-1, post-race 74.52±30.39ngL^-1, p<0.001). Markers of endurance performance such as running economy (10kmh^-1 223±18mlkg^-1km^-1; race pace 225±22mlkg^-1km^-1), VT (38.5±6.4mlkg^-1min^-1) and V˙O₂max (50.9±7.7mlkg^-1min^-1) were not associated with post-race cTnT. Runners exercise intensity correlated with post-race cTnT (mean HR %VT 104±5%, r=0.50; peak HR %VT 118±8%, r=0.68; peak HR %V˙O₂max 96±6, r=0.60, p<0.05) and was different between the low, medium and high cTnT groups (p<0.05).

CONCLUSIONS

CTnT increases above reference limits during a marathon. Magnitude of cTnT rise is related to exercise intensity relative to ventilatory threshold and V˙O₂max, but not individuals' absolute cardiopulmonary fitness, training state or running history.