High-sensitivity Troponins after a Standardized 2-hour Treadmill Run

Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance

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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.

The Main Causes and Mechanisms of Increase in Cardiac Troponin Concentrations Other Than Acute Myocardial Infarction (Part 1): Physical Exertion, Inflammatory Heart Disease, Pulmonary Embolism, Renal Failure, Sepsis

The causes and mechanisms of increased cardiac troponin T and I (cTnT and cTnI) concentrations are numerous and are not limited to acute myocardial infarction (AMI) (ischemic necrosis of cardiac myocytes). Any type of reversible or irreversible cardiomyocyte injury can result in elevated serum cTnT and cTnI levels. Researchers and practitioners involved in the diagnosis and treatment of cardiovascular disease, including AMI, should know the key causes and mechanisms of elevated serum cTnT and cTnI levels. This will allow to reduce or completely avoid diagnostic errors and help to choose the most correct tactics for further patient management. The purpose of this article is to discuss the main causes and mechanisms of increase in cardiac troponins concentrations in frequently occurring physiological (physical exertion, psycho-emotional stress) and pathological conditions (inflammatory heart disease, pulmonary embolism, chronic renal failure and sepsis (systemic inflammatory response)) not related to myocardial infarction.

T Cell Subsets' Distribution in Elite Karate Athletes as a Response to Physical Effort

Background

During karate fight muscles work at a very high intensity, and their contractions are extremely strong. The movement pattern contains a great number of feints, dodges, frequent changes in movements’ tempo and direction, hits and kicks, all of which is highly stressful for athlete’s organism, including the immune system.

Methods

T lymphocyte subsets’ distribution and selected cytokines in peripheral blood of three elite karate athletes aged 30 years old (range 21–31 years) with minimum 15 years of training experience were analysed in two experiments: at the beginning of the preparatory phase (a progressive test until exhaustion; an analysis of immune system’s selected parameters and cardiorespiratory fitness measures, including VO₂max, VE, AT, MVV, MET, Rf), and during the start-up period (Karate Championships; an analysis of selected parameters of the immune system).

Results

Maximal effort caused an increase in total lymphocyte percentage (p<0.05). A decrease in Th cells in recovery (p<0.05 compared to post-exercise), and an increase in Th naïve cells in recovery (p<0.05) were observed. A significant increase in CD8⁺ central memory cells (p<0.05) was found only after the progressive test, and no changes in both central and effector memory subsets of CD4⁺ cells during the first experiment. An increase (p<0.05) in Treg and Th1 and a decrease (p<0.05) in Th2 cells’ distribution during recovery time were found. Additionally, changes (p<0.05) in TNF-α, IL-6, IL-8, IL-10 and IL-12p70 were observed.

Conclusion

Post-effort disorder in immune balance activated compensation pathways involving CD4⁺ cells. Treg and Th1 cells seem to be subsets of key importance involved in the anabolic effect of physical effort, at least among karate athletes.

Assessment of Selected Exercise-induced CD3+ Cell Subsets and Cell Death Parameters Among Soccer Players

Background

Molecular mechanisms of biological adaptation to training in professional soccer players are unclear. The aim of this study was to assess the impact of progressive physical effort on peripheral T-cells and their molecular response.

Methods

Thirteen soccer players form Pogo Szczecin S.A., a top league soccer club, (median age 21, range 18– 31, years old) performed progressive efficiency tests on a mechanical treadmill until exhaustion at the start (period 1) and the end (period 2) of a competition round. Venous blood T-lymphocyte subsets, selected hallmarks of cell death and plasma cytokine levels were determined by flow cytometry three times: pre-exercise, post-exercise, and in recovery.

Results

Although significant changes in T, Tc and Tc-naïve cell percentages were found in both periods, Th-naïve cell percentages were altered only in period 1. Post-exercise IL-10 plasma levels were higher than pre-exercise, while an increase in TNF-α levels was noticed in recovery from both periods. An increase in recovery IL-12p70 levels was observed in the second period. Increases in the percentage of T-cells with disrupted mitochondrial membrane potentials, elevated levels of phosphorylated H2AX histones and increases in early apoptotic T-cells were also observed.

Conclusions

The immune system in soccer players creates space for naïve CD3⁺CD8⁺ cells by inducing mechanisms of cell death. It seems that the cumulative effect of physical activity during a competition round induced an adaptive mechanism, since the cell death process was induced faster during period 2.

Acute Response to Endurance Exercise Stress: Focus on Catabolic/anabolic Interplay Between Cortisol, Testosterone, and Sex Hormone Binding Globulin in Professional Athletes

Background

Endocrine system plays a major role in both permissive and regulatory activities in order to adequately respond to physical stress of exercise. But level and direction of activation depend on many factors and are not easily interpreted.

Methods

We tested a group of male professional athletes (21 water polo players and 15 wrestlers), together with 20 sedentary controls matched by age. All participants took a continuous progressive exercise stress test on a treadmill until exhaustion and plateau of oxygen consumption (VO₂). Blood samples for cortisol, sex hormone binding globulin (SHBG) and testosterone were drawn in four time points: baseline (B), start of the test (S), point of maximal strain (MAX) and in the 3^rd minute of recovery period (R).

Results

Cortisol levels significantly increased in both groups, but the response between S and MAX was more pronounced in controls (p=0.036). The athletes had significantly higher levels of cortisol in all points in test, except during R (p=0.118), when their cortisol levels gradually started to decline. Significant increase in total testosterone was in great deal a consequence of increase in SHBG level (p<0.01 for both). Consequently, calculated free testosterone significantly decreased during test (p=0.008), and the drop was more pronounced in athletes. This was in concordance with significant correlation between SHBG and cortisol level demonstrated in athletes, but not in controls.

Conclusions

It seems that high intensity endurance exercise favors catabolic response, but the level of response highly depends on a previous level of training.