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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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Wang X, Li S, Xia C, Meng X, Li Y, Weng S, Xu T, Wang Y, Kong Y, Lang X, Guo Y, Wang F. Exercise-induced cardiac troponin elevations and cardiac ventricular dysfunction assessed by tissue Doppler echocardiography and speckle tracking among non-elite runners in Beijing marathon. J Sci Med Sport 2024; 27:508-514. [PMID: 38697867 DOI: 10.1016/j.jsams.2024.04.005] [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: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES We aimed to identify the major determinants of cardiac troponin changes response to exercise among non-elite runners participating in the Beijing 2022 marathon, with a particular focus on the associations with the cardiac function assessed by tissue Doppler echocardiography and speckle tracking. DESIGN A prospective study. METHODS A total of 33 non-elite participants in the 2022 Beijing Marathon were included in the study. Echocardiographic assessment and blood sample collection were conducted before, immediately after, and two weeks after the marathon. Blood samples were analyzed using the same Abbot high-sensitivity cTnI STAT assay. Echocardiography included tissue Doppler and speckle tracking echocardiography. RESULTS Following the marathon, significant increases were observed in cardiac biomarkers, with hs-cTnI elevating from 3.1 [2.3-6.7] to 49.6 [32.5-76.9] ng/L (P < 0.0001). Over 72 % of participants had post-race hs-TnI levels surpassing the 99th percentile upper reference limit. There was a notable correlation between pre-marathon hs-cTnI levels (β coefficient, 0.56 [0.05, 1.07]; P = 0.042), weekly average training (β coefficient, -1.15 [-1.95, -0.35]; P = 0.009), and hs-cTnI rise post-marathon. Echocardiography revealed significant post-race cardiac function changes, including decreased E/A ratio (P < 0.0001), GWI (P < 0.0001), and GCW (P < 0.0001), with LVEF (β coefficients, 0.112 [0.01, 0.21]; P = 0.042) and RV GLS (β coefficients, 0.124 [0.01, 0.23]; P = 0.035) changes significantly associated with hs-TnI alterations. All echocardiographic and laboratory indicators reverted to baseline levels within two weeks. CONCLUSIONS Baseline hs-cTnI levels and weekly average training influence exercise-induced hs-cTnI elevation in non-elite runners. Echocardiography revealed post-race changes in cardiac function, with LVEF and RV GLS significantly associated with hs-TnI alterations. These findings contribute to understanding the cardiac response to exercise and could guide training and recovery strategies.
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Affiliation(s)
- Xiang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Sidong Li
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chenxi Xia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Peking University Fifth School of Clinical Medicine, Beijing, PR China
| | - Xuyang Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Yi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Sixian Weng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Tao Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Yutong Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Yiya Kong
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Xiaotong Lang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Ying Guo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Peking University Fifth School of Clinical Medicine, Beijing, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China; College of Life Science, University of Chinese Academy of Sciences, Beijing, China.
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3
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Papamichail A, Androulakis E, Xanthopoulos A, Briasoulis A. Effect of Training Load on Post-Exercise Cardiac Biomarkers in Healthy Children and Adolescents: A Systematic Review of the Existing Literature. J Clin Med 2023; 12:jcm12062419. [PMID: 36983423 PMCID: PMC10056214 DOI: 10.3390/jcm12062419] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postexercise release of cardiac biomarkers (cardiac troponins, cTn, and N-terminal pro b-type natriuretic peptide, NT-proBNP) is a well-known phenomenon in adults, although it remains unclear how it manifests in children. The aim of this review is to compare the pre-exercise with the post-exercise measurement of serum cardiac biomarkers, as well as to analyze their post-exercise release based on age, sex, and exercise intensity and duration. METHODS The terms troponin, football, swimmers, marathon, run, and exercise were used in a literature search at National Library of Medicine. The search was further refined by adding the keywords athletes, children, adolescents, and sport. RESULTS Fifteen pediatric studies and four studies with a mixed population of adults and children totaled 19 studies for the final analysis. In addition to them, some adult studies have been included for comparison. The kinetics of the cTn and NT-proBNP response after exercise have been the subject of our interest. While the impact of sport type, age, and sex has not yet been fully characterized, the existing data points to considerable impacts of sport intensity and duration on post-exercise biomarkers elevation. Most of the findings came from endurance sports, but the evidence is sparse. Furthermore, there is only limited data on women and less on young adults, African Caribbeans, and professional athletes. CONCLUSIONS Both amateur and competitive athletes can exhibit post-exercise release of both cTn and NT-proBNP. This is transient and lacks pathological significance, in contrast with adult population, in which exercise-induced increases in in these biomarker levels may not always be benign. While NT-proBNP release is still primarily driven by activity duration, cTnT release is additionally affected by exercise intensity. To define individual ranges of normality for postexercise cTn and NT-proBNP elevation, the role of several confounders (age, sex, sport type/intensity etc.) remains to be further elucidated.
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Affiliation(s)
| | - Emmanuel Androulakis
- Cardiology Department, St George's University of London, Blackshaw Road, London SW17 0QT, UK
| | - Andrew Xanthopoulos
- Medical School of Athens, National and Kapodistrian University of Athens, Goudi, 11527 Athens, Greece
| | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, Goudi, 11527 Athens, Greece
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Costache AD, Leon-Constantin MM, Roca M, Maștaleru A, Anghel RC, Zota IM, Drugescu A, Costache II, Chetran A, Moisă ȘM, Huzum B, Mitu O, Cumpăt C, Honceriu C, Mitu F. Cardiac Biomarkers in Sports Cardiology. J Cardiovasc Dev Dis 2022; 9:453. [PMID: 36547450 PMCID: PMC9781597 DOI: 10.3390/jcdd9120453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Sustained physical activity induces morphological and functional changes in the cardiovascular system. While mostly physiological, they can also become a trigger for major adverse cardiovascular events, the most severe of which are sudden cardiac arrest and sudden cardiac death. Therefore, any novel method which can help more accurately estimate the cardiovascular risk should be considered for further studying and future implementation in the standard protocols. The study of biomarkers is gaining more and more ground as they have already established their utility in diagnosing ischemic cardiac disease or in evaluating cardiac dysfunction in patients with heart failure. Nowadays, they are being implemented in the screening of apparently healthy individuals for the assessment of the cardiovascular risk. The aim of this paper is to gather published data regarding the measurements of cardiac biomarkers in athletes, i.e., troponins, myoglobin, CK-MB, NT-proBNP, and D-Dimers, and their potential use in the field of sports cardiology.
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Affiliation(s)
- Alexandru-Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Maria-Magdalena Leon-Constantin
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Mihai Roca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Alexandra Maștaleru
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Răzvan-Constantin Anghel
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ioana-Mădălina Zota
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Andrei Drugescu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Irina-Iuliana Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiology, ”St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Adriana Chetran
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiology, ”St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Ștefana-Maria Moisă
- Department of Mother and Child Medicine-Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Pediatrics I, “St. Maria” Clinical Emergency Hospital, 700309 Iasi, Romania
| | - Bogdan Huzum
- Department of Morphofunctional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiology, ”St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Carmen Cumpăt
- Department of Management, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Cezar Honceriu
- Faculty of Physical Education and Sports, “Alexandru Ioan Cuza” University, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
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5
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Costache AD, Roca M, Honceriu C, Costache II, Leon-Constantin MM, Mitu O, Miftode RȘ, Maștaleru A, Iliescu-Halițchi D, Halițchi-Iliescu CO, Ion A, Duca ȘT, Popa DM, Abălasei B, Mocanu V, Mitu F. Cardiopulmonary Exercise Testing and Cardiac Biomarker Measurements in Young Football Players: A Pilot Study. J Clin Med 2022; 11:2772. [PMID: 35628899 PMCID: PMC9143869 DOI: 10.3390/jcm11102772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 02/06/2023] Open
Abstract
Constant and intense physical activity causes physiological adaptive changes in the human body, but it can also become a trigger for adverse events, such as sudden cardiac arrest or sudden cardiac death. Our main objective was to assess the use of combined cardiopulmonary exercise testing (CPET) and cardiac biomarker determinants in young professional athletes. We conducted a study which involved the full examination of 19 football players, all male, aged between 18 and 20 years old. They underwent standard clinical and paraclinical evaluation, a 12-lead electrocardiogram (ECG), and transthoracic echocardiography (TTE). Afterwards, a tailored CPET was performed and peripheral venous blood samples were taken before and 3 h after the test in order to determine five biomarker levels at rest and post-effort. The measured biomarkers were cardiac troponin I (cTnI), myoglobin (Myo), the MB isoenzyme of creatine-kinase (CK-MB), the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and D-dimers. While cTnI and NT-proBNP levels were undetectable both at rest and post-effort in all subjects, the variations in Myo, CK-MB and D-dimers showed significant correlations with CPET parameters. This highlights the potential use of combined CPET and biomarker determinants to evaluate professional athletes, and encourages further research on larger study groups.
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Affiliation(s)
- Alexandru-Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Mihai Roca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Cezar Honceriu
- Faculty of Physical Education and Sports, “Alexandru Ioan Cuza” University, 700115 Iasi, Romania; (C.H.); (B.A.)
| | - Irina-Iuliana Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Maria-Magdalena Leon-Constantin
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Radu-Ștefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandra Maștaleru
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Dan Iliescu-Halițchi
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, Arcadia Hospital, 700620 Iasi, Romania
| | - Codruța-Olimpiada Halițchi-Iliescu
- Department of Mother and Child Medicine-Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- Department of Pediatrics, Arcadia Hospital, 700620 Iasi, Romania
| | - Adriana Ion
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Ștefania-Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Delia-Melania Popa
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
| | - Beatrice Abălasei
- Faculty of Physical Education and Sports, “Alexandru Ioan Cuza” University, 700115 Iasi, Romania; (C.H.); (B.A.)
| | - Veronica Mocanu
- Department of Morphofunctional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Florin Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
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