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Silva V, Matos Vilela E, Campos L, Miranda F, Torres S, João A, Teixeira M, Braga P, Fontes-Carvalho R. Suboptimal control of cardiovascular risk factors in myocardial infarction survivors in a cardiac rehabilitation program. Rev Port Cardiol 2021; 40:911-920. [PMID: 34922696 DOI: 10.1016/j.repce.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/10/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES As short-term mortality continues to decrease after myocardial infarction (MI), secondary prevention strategies attain increasing relevance. This study aimed at assessing the control of cardiovascular (CV) risk factors, including dyslipidemia, hypertension and diabetes, in a contemporary cohort of MI survivors who completed an exercise-based cardiac rehabilitation (EBCR) program. METHODS Observational, retrospective cohort study including patients admitted to a tertiary center with acute MI between November 2012 and April 2017, who completed a phase II EBCR program after discharge. Achievement of low-density lipoprotein (LD) cholesterol, blood pressure and HbA1c guideline recommended targets was assessed. Lipid profile parameters were assessed and compared at three time points (hospitalization, beginning and end of the program). RESULTS A total of 379 patients were included. Mean age was 58.8±10.6 years; 81% were male. Considering the European Society of Cardiology's guidelines on contemporary data collection, 61%, 87% and 71% achieved the recommended LDL cholesterol, blood pressure and HbA1c targets, respectively, at the end of the program. Combining all three risk factors, 42% achieved the recommended targets. High-sensitivity C-reactive protein decreased between the beginning and the end of the program [0.14 (0.08-0.29) mg/L to 0.12 (0.06-0.26) mg/L; p<0.001]. CONCLUSION Despite contemporary management strategies, including enrollment in a structured EBCR program, a substantial number of patients presented suboptimal control of CV risk factors. Considering the dyslipidemia, hypertension and diabetes results, less than half of the enrolled individuals achieved the recommended targets. These findings highlight a pivotal unmet need which could be particularly relevant in improving CV outcomes by enhancing secondary prevention profiles.
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Affiliation(s)
- Vasco Silva
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação e Desenvolvimento Cardiovascular (UniC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Eduardo Matos Vilela
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Lilibeth Campos
- Departamento de Medicina Física e Reabilitação, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Fátima Miranda
- Departamento de Medicina Física e Reabilitação, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Susana Torres
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana João
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Madalena Teixeira
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação e Desenvolvimento Cardiovascular (UniC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Silva V, Matos Vilela E, Campos L, Miranda F, Torres S, João A, Teixeira M, Braga P, Fontes-Carvalho R. Suboptimal control of cardiovascular risk factors in myocardial infarction survivors in a cardiac rehabilitation program. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Vilela EM, Ladeiras-Lopes R, João A, Torres S, Ribeiro J, Campos L, Miranda F, Nunes JP, Teixeira M, Fontes-Carvalho R. Cardiac rehabilitation in elderly myocardial infarction survivors: focus on circulatory power. Rev Cardiovasc Med 2021; 22:903-910. [PMID: 34565089 DOI: 10.31083/j.rcm2203097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 11/06/2022] Open
Abstract
Exercise-based cardiac rehabilitation (EBCR) is paramount after an acute myocardial infarction (AMI). Older individuals have been reported as having a worse prognosis after an AMI, and some series have reported differences in the functional response to EBCR. The peak circulatory power (CP), a non-invasive parameter, has been described as a surrogate for the cardiac power, showing promising results as a comprehensive measure of the cardiovascular response. Whilst this, data concerning the impact of EBCR on CP, particularly among elderly individuals, remains elusive. To address this issue, an observational, retrospective study including all patients admitted due to an AMI who completed a phase II EBCR programme between 11/2012 and 4/2017, was conducted, with CP being analysed by a symptom-limited cardiopulmonary exercise test. A total of 379 patients, 30% aged ≥65 years-old, were included. CP significantly improved after the EBCR programme (in all patients, as well as in both subgroups). Older patients presented lower CP than their younger counterparts at the beginning and the end of the programme, while presenting smaller improvements (122 ± 540 vs 293 ± 638 mmHg mL/kg/min, p = 0.013). This was maintained after adjusting for several potential confounding factors. A contemporary ECBR programme was associated with significant improvements in CP among AMI patients. Though those aged ≥65 years-old presented smaller improvements in CP than younger individuals, these still presented significant increases in this parameter. These results highlight the importance of EBCR in this challenging higher risk group of patients.
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Affiliation(s)
- Eduardo Matos Vilela
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Ricardo Ladeiras-Lopes
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal.,Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ana João
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Susana Torres
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Lilibeth Campos
- Physical and Rehabilitation Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Fátima Miranda
- Physical and Rehabilitation Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - José Pedro Nunes
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Madalena Teixeira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal.,Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Vilela EM, Ladeiras-Lopes R, Joao A, Braga J, Torres S, Ribeiro J, Primo J, Fontes-Carvalho R, Campos L, Miranda F, Nunes JP, Teixeira M, Braga P. Differential impact of a cardiac rehabilitation program in functional parameters according to patient gender. Am J Cardiovasc Dis 2020; 10:367-375. [PMID: 33224585 PMCID: PMC7675149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (EBCR) programs are of paramount importance in the management of acute myocardial infarction (AMI) survivors. Albeit this, female patients tend to be less referred for these programs, while also having a poorer prognosis. We aimed at assessing the impact of a contemporary EBCR program on functional parameters after an AMI, and specifically the impact of gender on its potential benefits. METHODS Observational, retrospective cohort study including all patients admitted to a tertiary center due to an AMI who completed a phase II EBCR program after discharge, between November 2012 and April 2017. Functional parameters were assessed by a symptom-limited cardiopulmonary exercise test (CPET). Patients were dichotomized according to gender. RESULTS A total of 379 patients were included, 19% of whom were women. After the program, peak oxygen uptake (pVO2) and exercise duration increased significantly (P<0.001). Though female patients presented a lower pVO2 and completed a shorter CPET at both the beginning and end of the study, there were no differences in the magnitude of improvement in these parameters between both groups [pVO2 delta 1.37 ± 3.08 vs 1.31 ± 2.62 mL/kg/min, P=0.876; CPET duration delta 120 (60-167) vs 85 (60-146), P=0.176]. CONCLUSIONS A contemporary EBCR program was associated with significant improvements in functional parameters, as assessed by CPET. Though female patients had lower levels of pVO2, the benefits of this program were similar among groups. These results highlight the importance of EBCR among this higher risk subset of patients.
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Affiliation(s)
| | - Ricardo Ladeiras-Lopes
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
- Cardiovascular Research Center, Faculty of Medicine, University of PortoPorto, Portugal
| | - Ana Joao
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
| | - Joana Braga
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
| | - Susana Torres
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
| | - Jose Ribeiro
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
| | - Joao Primo
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
- Cardiovascular Research Center, Faculty of Medicine, University of PortoPorto, Portugal
| | - Lilibeth Campos
- Department of Physical and Rehabilitation Medicine, Gaia Hospital CenterVila Nova de Gaia, Portugal
| | - Fatima Miranda
- Department of Physical and Rehabilitation Medicine, Gaia Hospital CenterVila Nova de Gaia, Portugal
| | | | - Madalena Teixeira
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
| | - Pedro Braga
- Department of Cardiology, Gaia Hospital CenterVila Nova de Gaia, Portugal
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de Oliveira MS, Fernandes TB, de Lima Medeiros Y, de Abreu Guimarães LD, Sanches GT, de Carvalho MF, Vilela EM. Diagnosis at different stages of paracoccidioidomycosis with oral manifestation: Report of two cases. J Mycol Med 2020; 30:101025. [PMID: 32855057 DOI: 10.1016/j.mycmed.2020.101025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/21/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
Abstract
Paracocciodiomycosis (PCDM) is a chronic systemic fungal infection, mainly affecting residents and rural workers, being characterized by a long incubation period, which it can take months or years without clinical manifestations, making diagnosis late and difficult. Depending on the stage of the disease, it can cause sequelae and low quality of life, so its correct diagnosis is of great importance for the accurate treatment. Therefore, the aim of this report is to present two cases of diagnosis of patients with PCDM at different stages, who developed chronic manifestations, pain, clinical involvement of the oral cavity and in one case also presented lung injury with fibrosis, as well as to weight loss, dysphagia and cachexia. Both of patients were treated with antifungal therapy and it was observed total remission of the lesions and no recurrences were detected.
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Affiliation(s)
- M S de Oliveira
- Dentistry Student, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - T B Fernandes
- Dentistry Student, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Y de Lima Medeiros
- Dentistry Student, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | | | - G T Sanches
- Department of Stomatology, University of São Paulo, São Paulo, Brazil
| | - M F de Carvalho
- Department of Dental Clinical, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - E M Vilela
- Department of Dental Clinical, Federal University of Juiz de Fora, Minas Gerais, Brazil.
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Vilela EM, Ladeiras Lopes R, Torres S, João A, Ribeiro J, Primo J, Fontes-Carvalho R, Campos L, Miranda F, Nunes JPL, Teixeira M, Braga P. Differential Impact of a Cardiac Rehabilitation Program on Functional Parameters in Elderly versus Non-Elderly Myocardial Infarction Survivors. Cardiology 2019; 145:98-105. [PMID: 31838463 DOI: 10.1159/000504875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation (EBCR) plays a pivotal role in the management of acute myocardial infarction (AMI). Studies have shown that older individuals have a worse prognosis after an AMI, attesting to the importance of risk reduction strategies. We aimed at assessing the impact of age (patients dichotomized as ≥65 years old or <65 years old) on the functional benefits of an EBCR program among AMI survivors. DESIGN Observational, retrospective cohort study. PARTICIPANTS All patients admitted due to an AMI who completed a phase II EBCR program after discharge, between November 2012 and April 2017. INTERVENTION EBCR program. MEASUREMENTS Functional parameters were assessed by a symptom-limited cardiopulmonary exercise test. RESULTS A total of 379 patients were included (30% aged ≥65 years). After the EBCR program, peak oxygen uptake (pVO2) and exercise duration increased significantly. Patients aged ≥65 years presented with more comorbidities and a lower functional capacity. Those aged ≥65 years presented significantly smaller improvements in pVO2 (0.79 ± 2.61 vs. 1.60 ± 3.11 mL/kg/min, p = 0.016) and exercise duration [75 (59-120) vs. 120 s (60-180), p = 0.002]. This was maintained after adjusting for several potential confounders. CONCLUSION Older patients have a worse functional capacity than their younger counterparts. Still, a contemporary EBCR program was associated with significant functional improvements among those aged ≥65 years. The smaller improvements even after adjustments for potential confounders suggest that physiological differences may contribute to this finding. These results highlight the relevance of EBCR among this higher-risk subgroup.
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Affiliation(s)
| | - Ricardo Ladeiras Lopes
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal.,Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Susana Torres
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Ana João
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Jose Ribeiro
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - João Primo
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal.,Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lilibeth Campos
- Department of Physical and Rehabilitation Medicine, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Fatima Miranda
- Department of Physical and Rehabilitation Medicine, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | | | - Madalena Teixeira
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
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Vilela EM, Caeiro D, Primo J, Braga P. A pivotal electrocardiographic presentation: reading between the lines. Neth J Med 2019; 77:297. [PMID: 31814579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Vilela EM, Ladeiras-Lopes R, Passos Silva M, Ruivo C, Miranda F, Campos L, Joao A, Torres S, Fonseca M, Ribeiro J, Braga P, Fontes-Carvalho R, Primo J, Teixeira M, Gama V. 57Impact of cardiac rehabilitation programs among myocardial infarction survivors not undergoing revascularization. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E M Vilela
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - R Ladeiras-Lopes
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - M Passos Silva
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - C Ruivo
- Hospital Santo Andre, Cardiology, Leiria, Portugal
| | - F Miranda
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Physical and Rehabilitation Medicine, Vila Nova de Gaia, Portugal
| | - L Campos
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Physical and Rehabilitation Medicine, Vila Nova de Gaia, Portugal
| | - A Joao
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - S Torres
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - M Fonseca
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - J Ribeiro
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - P Braga
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - J Primo
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - M Teixeira
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - V Gama
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
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Vilela EM, Sampaio F, Dias T, Barbosa AR, Primo J, Caeiro D, Fonseca M, Ribeiro VG. A critical electrocardiographic pattern in the age of cardiac biomarkers. Ann Transl Med 2018; 6:133. [DOI: 10.21037/atm.2018.02.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Vilela EM, Bastos JCC, Rodrigues RP, Nunes JPL. High-sensitivity troponin after running--a systematic review. Neth J Med 2014; 72:5-9. [PMID: 24457432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A systematic review was carried out to study the pattern of high-sensitivity cardiac troponin release after running (search performed on PubMed, ISI Web of Knowledge and Scopus databases). A total of ten reports were identified as meeting the pre-specified criteria (eight using high-sensitivity troponin T and two using high-sensitivity troponin I). The papers were published between 2009 and 2013, amounting to a total of 479 participants under study. Eight reports provided data comparing post-running troponin levels with the 99th percentile reference value. A total number of 296 participants, out of 424, showed post-running high-sensitivity troponin values higher than the 99th percentile reference value (69.8%). In conclusion, using high-sensitivity cardiac troponin assays, studies have shown that elevated post-running values are seen in more than two-thirds of runners. Whether troponin release in this setting represents a fully reversible phenomenon is currently unknown; the effects of strenuous running on long-term health are also uncertain.
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