Early evaluation of myocardial injury by means of high-sensitivity methods for cardiac troponins after strenuous and prolonged exercise

The kinetics of cardiac troponin T release during and after 1- and 6-h maximal cycling trials

OBJECTIVES

In this study, the effects of short-duration high-intensity exercise and long-duration exercise on high-sensitivity cardiac troponin T (hs-cTnT) levels were compared.

METHODS

Twelve male amateur cyclists performed 1- and 6-h cycling trials. In both exercise trials, hs-cTnT was assessed at rest, immediately postexercise and at 1, 3, 6, 12, and 24 h postexercise. Additionally, hs-cTnT levels were assessed every hour during the 6-h trial.

RESULTS

Exercise resulted in an increase in hs-cTnT levels in all subjects. Circulating hs-cTnT levels increased in both exercise trials (p < 0.001), with higher peak values occurring after the 1-h trial compared with those of the 6-h trial (p = 0.023). The upper reference limit (URL) exceeded 83 % of the participants in the 1-h trial and 42 % of the participants in the 6-h trial. There was substantial individual variability in peak hs-cTnT in both trials. Values of hs-cTnT were greater after exercise than during exercise for the 6-h trial. For both exercise trials, the maximum postexercise hs-cTnT values correlated with the %HRMAX (r = 0.906 for the 1-h trial, r = 0.735 for the 6-h trial). For the 1-h trial, the maximum postexercise hs-cTnT values were observed at 3 h in all subjects. No significant difference in the hs-cTnT values was observed for the 6-h trial during the first 12 h postexercise.

CONCLUSIONS

Our results demonstrated greater hs-cTnT levels in young male participants after a 1-h cycling trial than after a 6-h cycling trial, despite a substantially greater energy expenditure and total external work completed in the 6-h trial. Postexercise hs-cTnT values are associated with relative exercise intensity.

Cardiovascular risk evaluation in pregnancy: focus on cardiac specific biomarkers

Despite the evidence demonstrating the clinical utility of cardiac specific biomarkers in improving cardiovascular risk evaluation in several clinical conditions, even the most recent reviews and guidelines fail to consider their measurement in order to enhance the accuracy of the evaluation of cardiovascular risk in pregnant women. The aim of this review article was to examine whether the assay of cardiac specific biomarkers can enhance cardiovascular risk evaluation in pregnant women, first by reviewing the relationships between the physiological state of pregnancy and cardiac specific biomarkers. The clinical relevance of brain natriuretic peptide (BNP)/NT-proBNP and high-sensitivity cardiac troponin I/high-sensitivity cardiac troponin T (hs-cTnI/hs-cTnT) assay in improving cardiovascular risk evaluation is examined based on the results of clinical studies on subjects with normal and those with complicated pregnancy. Finally, the analytical approaches and clinical objectives related to cardio specific biomarkers are advocated in order to allow an early and more accurate evaluation of cardiovascular risk in pregnant women.

Natriuretic Peptides and Troponins to Predict Cardiovascular Events in Patients Undergoing Major Non-Cardiac Surgery

Patients undergoing major surgery have a substantial risk of cardiovascular events during the perioperative period. Despite the introduction of several risk scores based on medical history, classical risk factors and non-invasive cardiac tests, the possibility of predicting cardiovascular events in patients undergoing non-cardiac surgery remains limited. The cardiac-specific biomarkers, natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the perioperative period. This review paper aims to discuss the value of preoperative levels and perioperative changes in cardiac-specific biomarkers to predict adverse outcomes in patients undergoing major non-cardiac surgery. Based on several prospective observational studies and six meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing non-cardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cardiac troponin T and I, especially in elderly patients or those with comorbidities. This evidence should be considered in future international guidelines on the evaluation of perioperative risk in patients undergoing major non-cardiac surgery.

The Effects of Physical Inactivity and Exercise at Home in Young Patients with Congenital Heart Disease during the COVID-19 Pandemic

Background: The COVID-19 pandemic had a significant impact on the population’s ability to be physically active. Purpose: Evaluate the effect of the COVID-19 mitigation measures on exercise tolerance in patients with congenital heart disease (CHD). Materials and methods: All subjects (880, 6–18 years old) who performed a stress test at our hospital from October 2020 to February 2021 and had a similar test one year earlier were enrolled. A questionnaire on the degree of physical activity carried out in 2020 concerning the period prior to the pandemic was compiled. Exercise tolerance and the main anthropometric parameters between the first and second tests were compared. Results: 110 subjects (11.9 ± 4.1 years) were included in the study. The percentage of patients engaged in regular physical activity (RPA) decreased significantly during the pandemic (p < 0.001), and BMI increased significantly (p < 0.001), except among the subjects who began RPA during the lockdown, whereas test duration did not decrease significantly overall but increased in this last subgroup (p < 0.05) Conclusions: The COVID-19 lockdown led to a less active lifestyle with a significant increase in BMI in our group of CHD. These data could have negative effects on the risk profile of this population. RPA practiced at home seems to be effective in counteracting such effects.

Heart rate variability modifications in response to different types of exercise training in athletes

PURPOSE

Spectral analysis of heart rate variability (HRV) is a long-standing technique to indirectly assess neural cardiac regulation. This article specifically addressed how spectral analysis of HRV could help to understand neural cardiovascular adaptations to long-term exercise training and inform us on training status in athletes.

METHODS

We reviewed literature searching for articles investigating resting cardiovascular adaptations to long-tem exercise training through spectral analysis of HRV in athletes, from amateur to world class categories, practicing different sport disciplines, focusing, in particular, on a series of work performed over time in our laboratory, which may highlight how different types of exercise training differently affect neural cardiac regulation.

RESULTS

Spectral analysis of HRV has been shown its capability of detecting different adaptational changes in cardiac autonomic nervous system (ANS) regulation attending physical training in athletes of different sport disciplines. Studies showed that spectral analysis of HRV provide results that are sport-dependent and differ at individual level. ANS adaptations to exercise training are presented and discussed.

CONCLUSIONS

Reported studies indicate that spectral analysis of HRV is an effective tool to monitor and optimize the training process and also to predict athletic achievements in competitions. Cardiac ANS adaptations are strongly dependant on the type of training being performed. The individual nature of cardiac ANS adaptations should be considered to properly interpret the observed findings.