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Hernández-González V, Conesa-Milian E, Jové-Deltell C, Pano-Rodríguez Á, Legaz-Arrese A, Reverter-Masia J. Global research trends on cardiac troponin and physical activity among pediatric populations: a bibliometric analysis and science mapping study. Front Pediatr 2024; 12:1285794. [PMID: 38374876 PMCID: PMC10875851 DOI: 10.3389/fped.2024.1285794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024] Open
Abstract
Background Cardiac troponin (cTn) is a reliable marker for evaluating myocardial damage. cTn is a very specific protein involved in myocardial injury, and it is a key factor in the diagnosis of coronary syndromes. Bibliometric analysis was applied in the present work, with the main goal of evaluating global research on the topic of cardiac troponin in pediatric populations. Methods Publications about cardiac troponin and physical activity in pediatric populations were retrieved from the Social Sciences Citation Index (SSCI) and the Science Citation Index Expanded (SCIE) of the Web of Science Core Collection, and they were then analyzed. The study was able to identify the key bibliometric indicators, such as publications, keywords, authors, countries, institutions, and journals. For the analysis, VOSviewer, R-based Bibliometrix (4.2.2), and MapChart were used. Results Initially, 98 documents were identified; however, once inclusion and exclusion criteria were applied, the number of documents decreased to 88. The search yielded 79 original research articles and 9 reviews, almost all of which were published in the past 2 decades. The total number of citations (Nc) of the retrieved publications was 1,468, and the average number of citations per article (Na) was 16.68. In general, 508 authors were found to have participated in research about troponin; they were associated with 256 institutions, and their work was published in 65 different journals from around the world. The authors hailed from 30 countries and/or regions. The year 2022 was the most productive year for the publication of the selected documents. The bibliometric analysis provided information regarding levels of cooperation among authors and institutions. In fact, China, the United States, and England were the most productive nations, and the journal with the greatest number of publications on the topic was Pediatric Cardiology. Summary The number of publications and the trend line show that research on this topic has not yet reached a stage of maturity. There are referent investigators, countries, and institutions that have laid the foundations for subsequent studies on the analyzed topic.
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Affiliation(s)
- Vicenç Hernández-González
- Human Movement Research Group (RGHM), University of Lleida, Lleida, Spain
- Physical Education and Sport Section, University of Lleida, Lleida, Spain
| | - Enric Conesa-Milian
- Human Movement Research Group (RGHM), University of Lleida, Lleida, Spain
- Physical Education and Sport Section, University of Lleida, Lleida, Spain
| | - Carme Jové-Deltell
- Human Movement Research Group (RGHM), University of Lleida, Lleida, Spain
- Physical Education and Sport Section, University of Lleida, Lleida, Spain
| | - Álvaro Pano-Rodríguez
- Human Movement Research Group (RGHM), University of Lleida, Lleida, Spain
- Physical Education and Sport Section, University of Lleida, Lleida, Spain
| | - Alejandro Legaz-Arrese
- Section of Physical Education and Sports, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | - Joaquin Reverter-Masia
- Human Movement Research Group (RGHM), University of Lleida, Lleida, Spain
- Physical Education and Sport Section, University of Lleida, Lleida, Spain
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Wuestenfeld JC, Kastner T, Hesse J, Fesseler L, Frohberg F, Rossbach C, Wolfarth B. Differences in Troponin I and Troponin T Release in High-Performance Athletes Outside of Competition. Int J Mol Sci 2024; 25:1062. [PMID: 38256135 PMCID: PMC10816948 DOI: 10.3390/ijms25021062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Troponin I and troponin T are critical biomarkers for myocardial infarction and damage and are pivotal in cardiological and laboratory diagnostics, including emergency settings. Rapid testing protocols have been developed for urgent care, particularly in emergency outpatient clinics. Studies indicate that strenuous physical activity can cause transient increases in these troponin levels, which are typically considered benign. This research focused on 219 elite athletes from national teams, evaluating their troponin I and T levels as part of routine sports medical exams, independent of competition-related physical stress. The results showed that 9.2% (18 athletes) had elevated troponin I levels above the reporting threshold, while their troponin T levels remained within the normal range. Conversely, only 0.9% (two athletes) had normal troponin I but raised troponin T levels, and 2.3% (five athletes) exhibited increases in both markers. No significant cardiovascular differences were noted between those with elevated troponin levels and those without. This study concludes that elevated troponin I is a common response to the intense physical training endured by high-performance endurance athletes, whereas troponin T elevation does not seem to be directly linked to physical exertion in this group. For cardiac assessments, particularly when ruling out cardiac damage in these athletes, troponin T might be a more reliable indicator than troponin I.
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Affiliation(s)
- Jan C. Wuestenfeld
- Institute for Applied Training Science, Marschnerstrasse 29, 04109 Leipzig, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Sports Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Tom Kastner
- Institute for Applied Training Science, Marschnerstrasse 29, 04109 Leipzig, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Sports Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Judith Hesse
- Institute for Applied Training Science, Marschnerstrasse 29, 04109 Leipzig, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Sports Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Leon Fesseler
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Sports Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Florian Frohberg
- Institute for Applied Training Science, Marschnerstrasse 29, 04109 Leipzig, Germany
| | - Cornelius Rossbach
- Institute for Applied Training Science, Marschnerstrasse 29, 04109 Leipzig, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Sports Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernd Wolfarth
- Institute for Applied Training Science, Marschnerstrasse 29, 04109 Leipzig, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Sports Medicine, Charitéplatz 1, 10117 Berlin, Germany
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Conesa-Milian E, Cirer-Sastre R, Hernández-González V, Legaz-Arrese A, Corbi F, Reverter-Masia J. Cardiac Troponin Release after Exercise in Healthy Young Athletes: A Systematic Review. Healthcare (Basel) 2023; 11:2342. [PMID: 37628539 PMCID: PMC10454241 DOI: 10.3390/healthcare11162342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiac troponin (cTn) is a recognized marker used to assess damage to the heart muscle. Actual research has indicated that the levels of cTn increase after doing exercise in individuals who are in good health, and this is believed to be a result of a normal cellular process rather than a pathological one. The main goal of this study was to investigate the evidence of a postexercise release of cTn in child and adolescent athletes (6-17.9 years old) of different ages, sex, and sports disciplines. The Web of Science, MEDLINE, and Scopus databases were used to conduct the research up to March 2023. Three hundred and twenty-eight records were identified from the databases, however, only twenty-three studies were included in the review after being screened and quality-assessed by two independent authors. The gender, age of the participants, maturational status, and training level of the participants, the timing of sample collection, the exercise modality, and the number of participants with values above the cut-off reference were the data analyzed. Males, older young people, and individual sports seemed to have higher levels of serum cTn after practice exercise. Different methodologies, analyzers, and cut-off reference values make it difficult to compare the data among studies.
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Affiliation(s)
- Enric Conesa-Milian
- Department of Education Science, Faculty of Education, Psychology and Social Work, University of Lleida, 25003 Lleida, Spain; (V.H.-G.); (J.R.-M.)
- Consolidated Research Group Human Movement Generalitat de Catalunya, University of Lleida, 25003 Lleida, Spain; (R.C.-S.); (A.L.-A.); (F.C.)
| | - Rafel Cirer-Sastre
- Consolidated Research Group Human Movement Generalitat de Catalunya, University of Lleida, 25003 Lleida, Spain; (R.C.-S.); (A.L.-A.); (F.C.)
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida, 25192 Lleida, Spain
| | - Vicenç Hernández-González
- Department of Education Science, Faculty of Education, Psychology and Social Work, University of Lleida, 25003 Lleida, Spain; (V.H.-G.); (J.R.-M.)
- Consolidated Research Group Human Movement Generalitat de Catalunya, University of Lleida, 25003 Lleida, Spain; (R.C.-S.); (A.L.-A.); (F.C.)
| | - Alejandro Legaz-Arrese
- Consolidated Research Group Human Movement Generalitat de Catalunya, University of Lleida, 25003 Lleida, Spain; (R.C.-S.); (A.L.-A.); (F.C.)
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida, 25192 Lleida, Spain
- Section of Physical Education and Sports, Faculty of Health and Sports Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Francisco Corbi
- Consolidated Research Group Human Movement Generalitat de Catalunya, University of Lleida, 25003 Lleida, Spain; (R.C.-S.); (A.L.-A.); (F.C.)
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida, 25192 Lleida, Spain
| | - Joaquin Reverter-Masia
- Department of Education Science, Faculty of Education, Psychology and Social Work, University of Lleida, 25003 Lleida, Spain; (V.H.-G.); (J.R.-M.)
- Consolidated Research Group Human Movement Generalitat de Catalunya, University of Lleida, 25003 Lleida, Spain; (R.C.-S.); (A.L.-A.); (F.C.)
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Papamichail A, Androulakis E, Xanthopoulos A, Briasoulis A. Effect of Training Load on Post-Exercise Cardiac Biomarkers in Healthy Children and Adolescents: A Systematic Review of the Existing Literature. J Clin Med 2023; 12:jcm12062419. [PMID: 36983423 PMCID: PMC10056214 DOI: 10.3390/jcm12062419] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postexercise release of cardiac biomarkers (cardiac troponins, cTn, and N-terminal pro b-type natriuretic peptide, NT-proBNP) is a well-known phenomenon in adults, although it remains unclear how it manifests in children. The aim of this review is to compare the pre-exercise with the post-exercise measurement of serum cardiac biomarkers, as well as to analyze their post-exercise release based on age, sex, and exercise intensity and duration. METHODS The terms troponin, football, swimmers, marathon, run, and exercise were used in a literature search at National Library of Medicine. The search was further refined by adding the keywords athletes, children, adolescents, and sport. RESULTS Fifteen pediatric studies and four studies with a mixed population of adults and children totaled 19 studies for the final analysis. In addition to them, some adult studies have been included for comparison. The kinetics of the cTn and NT-proBNP response after exercise have been the subject of our interest. While the impact of sport type, age, and sex has not yet been fully characterized, the existing data points to considerable impacts of sport intensity and duration on post-exercise biomarkers elevation. Most of the findings came from endurance sports, but the evidence is sparse. Furthermore, there is only limited data on women and less on young adults, African Caribbeans, and professional athletes. CONCLUSIONS Both amateur and competitive athletes can exhibit post-exercise release of both cTn and NT-proBNP. This is transient and lacks pathological significance, in contrast with adult population, in which exercise-induced increases in in these biomarker levels may not always be benign. While NT-proBNP release is still primarily driven by activity duration, cTnT release is additionally affected by exercise intensity. To define individual ranges of normality for postexercise cTn and NT-proBNP elevation, the role of several confounders (age, sex, sport type/intensity etc.) remains to be further elucidated.
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Affiliation(s)
| | - Emmanuel Androulakis
- Cardiology Department, St George's University of London, Blackshaw Road, London SW17 0QT, UK
| | - Andrew Xanthopoulos
- Medical School of Athens, National and Kapodistrian University of Athens, Goudi, 11527 Athens, Greece
| | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, Goudi, 11527 Athens, Greece
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Abstract
BACKGROUND Chest pain is a common complaint among paediatric patients and cardiac troponin (cTn) level is often part of the initial emergency department evaluation. It is well known that after intense endurance exercise cTn levels can be elevated in patients with otherwise healthy hearts, however the effect shorter duration exercise has on cTn levels in this population is not known. OBJECTIVE Determine the behaviour of cTn levels in healthy children and adolescent patients after short burst, high-intensity aerobic exercise. METHODS Patients without haemodynamically significant heart disease referred for a treadmill exercise stress test (EST) were recruited over a 6-month period. cTn levels were measured prior to exercise and 4 hours after exercise. RESULTS Thirteen patients enrolled. Indications for EST were exertional syncope (six), chest pain (four), and long QT syndrome (three). The median exercise time was 12.9 (9.9-13.7) minutes with an average endurance at the fiftieth percentile for age and maximum heart rate rose to an average of 92 (74-98)% of the predicted peak for age. cTn levels prior to exercise were undetectable in all patients. There was no cTn rise in any patient after exercise. There were no ischaemic changes or arrhythmias on exercise electrocardiograms. CONCLUSION Serum cTn levels do not rise significantly in healthy children after short duration, high-intensity aerobic exercise. Physicians evaluating paediatric patients with an elevated cTn level after less than prolonged strenuous activity likely cannot attribute this lab value solely to exercise and may need to undertake further cardiac investigation.
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Li S, Shaharudin S, Cirer-Sastre R, Li F, Abdul Manaf F, Mohd Shukri MF. Effects of high-intensity interval exercise on cardiac troponin elevation when comparing with moderate-intensity continuous exercise: a systematic review and meta-analysis. PeerJ 2023; 11:e14508. [PMID: 36647447 PMCID: PMC9840388 DOI: 10.7717/peerj.14508] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/13/2022] [Indexed: 01/12/2023] Open
Abstract
Background This systematic review and meta-analysis aimed to compare the effects of high-intensity interval exercise (HIIE) with different recovery modes versus moderate-intensity continuous exercise (MICE) on cardiac troponin (cTn) elevation. Methodology A literature search was conducted in four databases: Scopus, PubMed, EBSCO and Web of Science from January 2010 to June 2022. The articles were screened, evaluated for quality before data were extracted. The review protocol was registered at PROSPERO (CRD42021245649). Standardized mean differences (SMD) of peak cTn were analyzed with a 95% confidence interval (95% CI) using Revman 5.4 software. Results Six studies satisfied the inclusion criteria with a total of 92 and 79 participants for HIIE and MICE, respectively. Overall, there was no significant difference between HIIE and MICE in the elevation of cardiac troponin T (SMD: 0.41 [95% CI [-0.21, 1.03]], p = 0.20, I 2 = 77%, p for heterogeneity <0.01). In subgroup analysis, HIIE with passive recovery elicits greater release of cardiac troponin T than MICE (SMD: 0.85 [95% CI [0.44, 1.27]], p < 0.01, I 2 = 32%, p for heterogeneity = 0.22). Changes of cardiac troponin T (SMD: 0.41 [95% CI [-0.21, 1.03]], p = 0.20, I 2 = 77%, p for heterogeneity < 0.01) after HIIE with active recovery were not significantly different from those of MICE. Conclusions There was no significant difference between HIIE and MICE in the elevation of cardiac troponin T. However, HIIE with passive recovery elicited more cardiac troponin T elevation than MICE, which should be considered when developing exercise programs.
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Affiliation(s)
- Shuoqi Li
- School of Sports Science, Nantong University, Nantong, China,Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Shazlin Shaharudin
- Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Rafel Cirer-Sastre
- National Institute of Physical Education of Catalonia; Research Group Human Movement, Universitat de Lleida, Lleida, Spain
| | - Feifei Li
- Center for Health and Exercise Science Research; Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Faizal Abdul Manaf
- Defence Fitness Academy, Universiti Pertahanan Nasional Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Faiz Mohd Shukri
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia,Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia
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White EJ, Susman SJ, Bouffler A, Leahy JC, Griffin SM, Christenson R, Newby LK, Gordee A, Kuchibhatla M, Limkakeng AT. Predictors of Stress-Delta High-Sensitivity Troponin T in Emergency Department Patients Undergoing Stress Testing. Cureus 2022; 14:e29601. [PMID: 36321030 PMCID: PMC9599911 DOI: 10.7759/cureus.29601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/08/2022] Open
Abstract
Background and objective Elevations in high-sensitivity troponin T (hs-TnT) are frequently observed following extreme physical exercise. In light of this, we sought to determine whether specific clinical characteristics are associated with this phenomenon in patients undergoing cardiac exercise tolerance testing (ETT). Methods We conducted a retrospective analysis of a prospectively collected biospecimen repository of 257 patients undergoing a stress echocardiogram for possible acute coronary syndrome (ACS). Ischemic electrocardiogram (ECG) changes during ETT and the presence or absence of ischemia on imaging were determined by a board-licensed cardiologist. N-terminal pro-brain natriuretic peptide (NT-proBNP) and hs-TnT assays were obtained immediately before and two hours following ETT. We developed linear regression models including several clinical characteristics to predict two-hour stress-delta hs-TnT. Variable selection was performed using the least absolute shrinkage and selection operator (LASSO). Results The mean age of the patients was 52 years [standard deviation (SD): 11.4]; 125 (48.6%) of them were men, and 88 (34.2%) were African-American. Twenty-two patients (8.6%) had ischemia evident on echocardiography, and 31 (12.1%) had ischemic ECG changes during exercise. The mean baseline hs-TnT was 5.6 ng/L (SD: 6.4) and the mean two-hour hs-TnT was 7.1 ng/L (SD: 10.2). Age and ischemic ECG changes were associated with two-hour stress-delta hs-TnT values. Conclusions Based on our findings, ischemic changes in stress ECG and age were associated with an increase in hs-TnT levels following exercise during a stress echo.
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Plasma Concentrations of Vinculin versus Talin-1 in Coronary Artery Disease. Med Sci (Basel) 2022; 10:medsci10030046. [PMID: 36135831 PMCID: PMC9502881 DOI: 10.3390/medsci10030046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Vinculin and talin-1, which are cytoskeletal proteins affecting focal adhesions, were reported to be down-expressed in atherosclerotic lesions. Recently, we reported high concentrations of plasma talin-1 in patients with coronary artery disease (CAD). However, blood vinculin concentrations in CAD patients have not been clarified. Plasma vinculin concentrations as well as talin-1 were studied in 327 patients in whom coronary angiography was performed. CAD was proven in 177 patients (1-vessel, n = 79; 2-vessel, n = 57; 3-vessel disease, n = 41). However, vinculin concentrations were not markedly different between the CAD(-) and CAD groups (median 122.5 vs. 119.6 pg/mL, p = 0.325) or among patients with CAD(-), 1-, 2-, and 3-vessel diseases (122.5, 112.8, 107.9, and 137.2 pg/mL, p = 0.202). In contrast, talin-1 concentrations were higher in CAD than the CAD(-) group (0.29 vs. 0.23 ng/mL, p = 0.006) and increased stepwise in the number of stenotic vessels: 0.23 in CAD(-), 0.28 in 1-vessel, 0.29 in 2-vessel, and 0.33 ng/mL in 3-vessel disease (p = 0.043). No correlation was observed between vinculin and talin-1 concentrations. In multivariate analysis, vinculin concentrations were not a factor for CAD. In conclusion, plasma vinculin concentrations in patients with CAD were not high and were not associated with the presence or severity of CAD.
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Birat A, Ratel S, Dodu A, Grossoeuvre C, Dupont AC, Rance M, Morel C, Nottin S. A long duration race induces a decrease of left ventricular strains, twisting mechanics and myocardial work in trained adolescents. Eur J Sport Sci 2022:1-11. [PMID: 35757854 DOI: 10.1080/17461391.2022.2093131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND We investigated the acute cardiac consequences of a long-duration (>5 h) adventure race in adolescent athletes from evaluations of left ventricular (LV) strains and myocardial work. METHODS Twenty trained male adolescents (i.e. 8 ± 4 hours/week of endurance sports) aged 14 to 17 years participated in a competitive long-duration adventure race. Blood samples were collected before, immediately and 24 h after the race to determine the time course of troponin I (cTnI) considered as a myocardial damage biomarker. Resting echocardiography were conducted before and after the race to assess myocardial regional strains, LV twisting mechanics and myocardial work using speckle tracking echocardiography. RESULTS The mean completion time of the race was 05:38 ± 00:20 h, with a mean heart rate (HR) of 83 ± 5% of maximal HR. cTnI concentration significantly increased in 16/20 participants after the race (pre: 0.001 ± 0.002 vs. post: 0.244 ± 0.203 ng·dL-1, p < 0.001) and returned to baseline within 24 h. Stroke volume, ejection fraction and global longitudinal strains remained unchanged after the race while LV twist and global myocardial work significantly decreased (8.6 ± 3.3 vs. 6.3 ± 3.3 deg and 2080 ± 250 vs. 1781 ± 334 mmHg%, p < 0.05). Diastolic function, indexes of myocardial relaxation and LV untwisting rate (-91.0 ± 19.0 vs. -56.4 ± 29.1 deg·s-1, p < 0.001) were affected after the race. CONCLUSION We demonstrated for the first time that, in trained adolescents, a high-intensity endurance exercise of several hours induced an increase of the cTnI concentration associated with an alteration of myocardial function.
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Affiliation(s)
- Anthony Birat
- EA3533 AME2P, Université Clermont Auvergne, Clermont-Ferrand 63000, France.,Fédération Française Triathlon, Saint Denis 93210, France
| | - Sébastien Ratel
- EA3533 AME2P, Université Clermont Auvergne, Clermont-Ferrand 63000, France
| | - Alexandre Dodu
- Fédération Française Triathlon, Saint Denis 93210, France
| | | | - Anne-Charlotte Dupont
- Fédération Française Triathlon, Saint Denis 93210, France.,U1254 INSERM, Imagerie Adaptative Diagnostique et Interventionnelle (ADI), Université de Lorraine, Nancy 54510, France
| | - Mélanie Rance
- Centre de Ressources et d'Expertise de la Performance Sportive (CREPS), Bellerive-sur-Allier 03700, France
| | - Claire Morel
- Centre de Ressources et d'Expertise de la Performance Sportive (CREPS), Bellerive-sur-Allier 03700, France
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Cantinotti M, Clerico A, Giordano R, Assanta N, Franchi E, Koestenberger M, Marchese P, Storti S, D'Ascenzi F. Cardiac Troponin-T Release After Sport and Differences by Age, Sex, Training Type, Volume, and Intensity: A Critical Review. Clin J Sport Med 2022; 32:e230-e242. [PMID: 34009785 DOI: 10.1097/jsm.0000000000000940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postexercise release of cardiac troponin (cTn) is a well-known phenomenon, although the influence of various confounders remains unclear. The aim of this critical review was to analyze the postexercise release of cTn according to age, sex, different types of sport, exercise intensity and duration, and training level. DATA SOURCES A literature search was performed within the National Library of Medicine using the following keywords: cTn, peak, release, and exercise. The search was further refined by adding the keywords athletes, children/adolescents, and sport. MAIN RESULTS For final analysis, 52 studies were included: 43 adult studies, 4 pediatric studies, and 5 with a mixed population of adults and children. Several studies have investigated the kinetics of cTn response after exercise with different biomarkers. The current evidence suggests that sport intensity and duration have significant effects on postexercise cTn elevation, whereas the influence of the type of sport, age, and sex have been not completely defined yet. Most data were obtained during endurance races, whereas evidence is limited (or almost absent), particularly for mixed sports. Data on young adults and professional athletes are limited. Finally, studies on women are extremely limited, and those for non-White are absent. CONCLUSIONS Postexercise release of cTn can be observed both in young and master athletes and usually represents a physiological phenomenon; however, more rarely, it may unmask a subclinical cardiac disease. The influence of different confounders (age, sex, sport type/intensity/duration, and training level) should be better clarified to establish individualized ranges of normality for postexercise cTn elevation.
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Affiliation(s)
- Massimiliano Cantinotti
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
- Pediatric Cardiology Unit, Institute of Clinical Physiology (IFC) National Research Institute (CNR), Pisa, Italy
| | - Aldo Clerico
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Raffaele Giordano
- Department Advanced Biomedica Sciences, University of Naples Federico II, Naples, Italy
| | - Nadia Assanta
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Martin Koestenberger
- Department Advanced Biomedica Sciences, University of Naples Federico II, Naples, Italy
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria; and
| | - Pietro Marchese
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Simona Storti
- Pediatric Cardiology Unit, Fondazione CNR-Regione Toscana G. Monasterio, Massa, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
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Exercise-Induced Release of Cardiac Troponins in Adolescent vs. Adult Swimmers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031285. [PMID: 33535387 PMCID: PMC7908416 DOI: 10.3390/ijerph18031285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
To examine the exercise-induced release of cardiac troponin T (cTnT) in adolescent and adult swimmers. Thirty-two trained male (18 adolescents, 14 adults) swam at maximal pace in a 45 min distance trial, and blood samples were drawn before, immediately and 3 h after exercise for subsequent cTnT analysis and comparison. Having comparable training experience and baseline values of cTnT (p = 0.78 and p = 0.13), adults exercised at lower absolute and relative intensity (p < 0.001 and p < 0.001, respectively), but presented higher immediate cTnT after exercise than adolescents (p < 0.001). Despite that, peak concentrations were observed at 3 h post exercise and peak elevations were comparable between groups (p = 0.074). Fourteen (44%) apparently healthy subjects exceeded the cutoff value for myocardial infarction (MI). Adolescents presented a delayed elevation of cTnT compared with adults, but achieved similar peak values.
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Mascia G, Pescetelli F, Baldari A, Gatto P, Seitun S, Sartori P, Pieroni M, Calò L, Della Bona R, Porto I. Interpretation of elevated high-sensitivity cardiac troponin I in elite soccer players previously infected by severe acute respiratory syndrome coronavirus 2. Int J Cardiol 2020; 326:248-251. [PMID: 33242510 PMCID: PMC7682525 DOI: 10.1016/j.ijcard.2020.11.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Objectives To clarify the meaning of elevated cardiac troponin in elite soccer athletes previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and screened for cardiovascular involvement in the wake of competitive sport resumption. Methods We designed a retrospective cohort study with the collaboration of two Italian Serie A teams. Soccer players from both rosters (58 athletes) were systematically analysed. For every SARS-CoV-2 positive athlete, the Italian Soccer Federation protocol requested full blood tests including high-sensitivity cardiac troponin I (hs-cTnI), along with a complete cardiovascular examination. We extended the analysis to SARS-CoV-2 negative athletes. Results A total of 13/58 players (22.4%) suffered from SARS-CoV-2infection: all had a negative cardiovascular examination and 2/13 (15%) showed increased hs-cTnI values (120.8 pg/ml and 72,6 pg/ml, respectively; upper reference level 39.2 pg/ml), which did not track with inflammatory biomarkers. Regarding the 45/58 (77.6%) non infected athletes, a slight increase in hs-cTnI was observed in 2 (4.5%) subjects (values: 61 pg/ml and 75 pg/ml respectively). All hs-cTnI positive athletes (4/58, 7%) underwent cardiac magnetic resonance (CMR), that excluded any cardiac injury. Conclusions In our retrospective study, SARS-CoV-2 infection in elite soccer athletes was not associated to clinical or biomarkers abnormalities. Increased hs-cTnI was rare and not significantly associated with previous SARS-COV2 infection nor with pathological findings at CMR, albeit elevated hs-cTnI was numerically more prevalent in the infected group.
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Affiliation(s)
- Giuseppe Mascia
- Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network
| | - Fabio Pescetelli
- Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy
| | - Amedeo Baldari
- U.C. Sampdoria, Torre B, Piazza Borgo Pila, 39/Piano 5, 16129 Genova, Italy
| | - Piero Gatto
- Genoa Cricket and Soccer Club, Centro Sportivo PIO XII - G. Signorini, via Ronchi 67, Genova, Italy
| | - Sara Seitun
- Department of Radiology and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network, Italy
| | - Paolo Sartori
- Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network
| | | | - Leonardo Calò
- Department of Cardiology, Policlinico Casillino Hospital, Rome, Italy
| | - Roberta Della Bona
- Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network
| | - Italo Porto
- Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network; Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy.
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Rodriguez-Gonzalez M, A Perez-Reviriego A, Castellano-Martinez A. Current role of cardiac biomarkers in extra-cardiac diseases in children. Biomark Med 2020; 14:1183-1187. [PMID: 33021387 DOI: 10.2217/bmm-2020-0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Moises Rodriguez-Gonzalez
- Pediatric Cardiology Department of Puerta del Mar University Hospital, Cadiz, Spain
- Biomedical Research & Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Spain
| | - Alvaro A Perez-Reviriego
- Pediatric Cardiology Department of Puerta del Mar University Hospital, Cadiz, Spain
- Biomedical Research & Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Spain
| | - Ana Castellano-Martinez
- Pediatric Nephrology Department of Puerta del Mar University Hospital, Cadiz, Spain
- Biomedical Research & Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Spain
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Cirer-Sastre R, Legaz-Arrese A, Corbi F, López-Laval I, George K, Reverter-Masia J. Influence of maturational status in the exercise-induced release of cardiac troponin T in healthy young swimmers. J Sci Med Sport 2020; 24:116-121. [PMID: 32680701 DOI: 10.1016/j.jsams.2020.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To determine the influence of maturational status on the release of cardiac troponin T (cTnT) induced by a bout of 30min, high-intensity, continuous exercise. DESIGN Quasi-experimental, cross-sectional study. METHODS Seventy male, young, well trained swimmers (age range 7-18 years, training experience 1-11 years) were classified by maturational stages: Tanner stage I (n=14), II (n=15), III (n=15), IV (n=13), and V (n=13). Participants underwent a distance-trial of 30min continuous swimming, and cTnT was measured before, immediately after and 3h after exercise. Changes in cTnT over time were compared among groups, and associated with exercise load. RESULTS Basal cTnT was higher in Tanner-V (3.8-8.1ng/L) compared with I (1.5-5.5ng/L, p<0.001), II (1.5-4.5ng/L, p<0.001) and III (1.5-6.8ng/L, p=0.003), and in IV (1.5-6.3ng/L) compared with II (p=0.036). Maximal elevations of cTnT from baseline were notable (p<0.001) and comparable among maturational stages (p=0.078). The upper reference limit for myocardial injury was exceeded in 35.7% of the participants, without differences among groups (p=0.18). Baseline cTnT correlated with participant characteristics, and maximal cTnT elevations from baseline with exercise internal load (%HRpeak, rs=0.34, p= 0.003; %HRmean, rs=0.28, p=0.02). CONCLUSIONS Maturational status influences positively absolute pre- and post-exercise cTnT but not its elevation after a bout of 30min, high-intensity, continuous exercise.
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Affiliation(s)
- Rafel Cirer-Sastre
- National Institute of Physical Education of Catalonia (INEFC), Universitat de Lleida (UdL), Spain; Grup de Recerca Moviment Humà, Universitat de Lleida (UdL), Spain.
| | | | - Francisco Corbi
- National Institute of Physical Education of Catalonia (INEFC), Universitat de Lleida (UdL), Spain; Grup de Recerca Moviment Humà, Universitat de Lleida (UdL), Spain
| | - Isaac López-Laval
- Section of Physical Education and Sports, University of Zaragoza, Spain
| | - Keith George
- Research Institute for Sport and Exercise Sciences, School of Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom
| | - Joaquín Reverter-Masia
- Grup de Recerca Moviment Humà, Universitat de Lleida (UdL), Spain; Section of Physical Education, Universitat de Lleida (UdL), Spain
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15
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Cirer-Sastre R, Legaz-Arrese A, Corbi F, López-Laval I, Puente-Lanzarote JJ, Hernández-González V, Reverter-Masia J. Cardiac Troponin T Release after Football 7 in Healthy Children and Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E956. [PMID: 32033112 PMCID: PMC7037606 DOI: 10.3390/ijerph17030956] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 01/10/2023]
Abstract
The objective of this study was to compare the release of cardiac troponin T (cTnT) after a football 7 match between two cohorts of children and adult players. Thirty-six male football players (children = 24, adult = 12) played a football 7 match, and cTnT was measured before, and 3 h after exercise. Concentrations of cTnT were compared between groups and time, and correlated with participants' characteristics, as well as internal and external exercise load. Cardiac troponin T was elevated in all participants (p < 0.001), and exceeded the upper reference limit for myocardial infarction in 25 (~70%) of them. Baseline concentrations were higher in adults (p < 0.001), but the elevation of cTnT was comparable between the groups (p = 0.37). Age (p < 0.001), body mass (p = 0.001) and height (p < 0.001), and training experience (p = 0.001) were associated to baseline cTnT values, while distance (p < 0.001), mean speed (p < 0.001), and peak (p = 0.013) and mean (p = 0.016) heart rate were associated to the elevation of cTnT. The present study suggests that a football 7 match evoked elevations of cTnT during the subsequent hours in healthy players regardless of their age. However, adults might present higher resting values of cTnT than children. In addition, results suggest that the exercise-induced elevations of cTnT might be mediated by exercise load but not participant characteristics.
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Affiliation(s)
- Rafel Cirer-Sastre
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida (UdL), Partida la Caparrella s/n, E-25192 Lleida, Spain;
- Research Group Human Movement (RGHM), Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain; (V.H.-G.); (J.R.-M.)
| | - Alejandro Legaz-Arrese
- Section of Physical Education and Sports, University of Zaragoza, Calle de Pedro Cerbuna, 50009 Zaragoza, Spain; (A.L.-A.); (I.L.-L.)
| | - Francisco Corbi
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida (UdL), Partida la Caparrella s/n, E-25192 Lleida, Spain;
- Research Group Human Movement (RGHM), Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain; (V.H.-G.); (J.R.-M.)
| | - Isaac López-Laval
- Section of Physical Education and Sports, University of Zaragoza, Calle de Pedro Cerbuna, 50009 Zaragoza, Spain; (A.L.-A.); (I.L.-L.)
| | | | - Vicenç Hernández-González
- Research Group Human Movement (RGHM), Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain; (V.H.-G.); (J.R.-M.)
- Section of Physical Education, Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain
| | - Joaquin Reverter-Masia
- Research Group Human Movement (RGHM), Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain; (V.H.-G.); (J.R.-M.)
- Section of Physical Education, Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain
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Cirer-Sastre R, Legaz-Arrese A, Corbi F, López-Laval I, Puente-Lanzarote J, Hernández-González V, Reverter-Masià J. Effect of Training Load on Post-Exercise Cardiac Troponin T Elevations in Young Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4853. [PMID: 31810338 PMCID: PMC6926666 DOI: 10.3390/ijerph16234853] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/16/2019] [Accepted: 11/29/2019] [Indexed: 12/18/2022]
Abstract
Training load (TL) metrics are usually assessed to estimate the individual, physiological and psychological, acute, and adaptive responses to training. Cardiac troponins (cTn) reflect myocardial damage and are routinely analyzed for the clinical diagnosis of myocardial injury. The association between TL and post-exercise cTn elevations is scarcely investigated in young athletes, especially after playing common team sports such as soccer. The objective of this study was to assess the relationship between TL measurements during a small-sided soccer game and the subsequent increase in cTn in young players. Twenty male soccer players (age 11.9 ± 2 years, height 151 ± 13 cm, weight 43 ± 13 kg) were monitored during a 5 × 5 small-sided game and had blood samples drawn before, immediately after, and 3 h after exercise for a posterior analysis of high-sensitivity cardiac troponin T (hs-cTnT). Internal, external, and mixed metrics of TL were obtained from the rating of perceived exertion (RPE), heart rate (HR), and GPS player tracking. The results show that the concentration of hs-cTnT peaked at 3 h post-exercise in all participants. The magnitude of hs-cTnT elevation was mainly explained by the exercise duration in the maximal heart rate zone (Maximum Probability of Effect (MPE) = 92.5%), time in the high-speed zone (MPE = 90.4 %), and distance in the high-speed zone (MPE = 90.45%). Our results support the idea that common metrics of TL in soccer, easily obtained using player tracking systems, are strongly associated with the release of hs-cTnT in children and adolescents.
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Affiliation(s)
- Rafel Cirer-Sastre
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida (UdL), Partida la Caparrella s/n, E-25192 Lleida, Spain
- Research Group Human Movement (RGHM), Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain
| | - Alejandro Legaz-Arrese
- Section of Physical Education and Sports, University of Zaragoza, Calle de Pedro Cerbuna, 50009 Zaragoza, Spain
| | - Francisco Corbi
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida (UdL), Partida la Caparrella s/n, E-25192 Lleida, Spain
- Research Group Human Movement (RGHM), Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain
| | - Isaac López-Laval
- Section of Physical Education and Sports, University of Zaragoza, Calle de Pedro Cerbuna, 50009 Zaragoza, Spain
| | | | - Vicenç Hernández-González
- Research Group Human Movement (RGHM), Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain
- Section of Physical Education, Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain
| | - Joaquín Reverter-Masià
- Research Group Human Movement (RGHM), Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain
- Section of Physical Education, Universitat de Lleida (UdL), Plaça de Víctor Siurana, 25003 Lleida, Spain
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