Reproducibility and clinical significance of exercise-induced increases in cardiac troponins and N-terminal pro brain natriuretic peptide in endurance athletes

Scharhag, Jürgen; Urhausen, Axel; Schneider, G??nther; Herrmann, Markus; Schumacher, Katrin; Haschke, Michaela; Krieg, Anne; Meyer, Tim; Herrmann, Wolfgang; Kindermann, Wilfried

doi:10.1097/00149831-200606000-00015

Cited by 79 publications

(33 citation statements)

References 34 publications

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“…It is important to mention that a significant increase in BNP or proBNP after exposure to HBO (68) and simulated diving (69), and also even after studying the effects of immersion (70) and exposure to cold (71) was not observed. Considering these data and the fact that numerous studies have shown an increase of BNP levels after exercise (72–76), it is evident that physical activity plays an important role in BNP increase after diving.…”

Section: Cardiovascular Response To Scuba Divingmentioning

confidence: 85%

Recreational scuba diving: negative or positive effects of oxidative and cardiovascular stress?

2014

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Environmental conditions and increased physical activity during scuba diving are followed by increased production of free radicals and disturbed redox balance. Redox balance disorder is associated with damage of cellular components, changes of cellular signaling pathways and alterations of gene expression. Oxidative stress leads to increased expression of sirtuins (SIRTs), molecules which play an important role in the antioxidant defense, due to their sensitivity to the changes in the redox status and their ability to regulate redox homeostasis. These facts make SIRTs interesting to be considered as molecules affected by scuba diving and in that sense, as potential biomarkers of oxidative status or possible drug targets in reduction of reactive oxygen species (ROS) accumulation. In addition, SIRTs effects through currently known targets make them intriguing molecules which can act positively on health in general and whose expression can be induced by scuba diving.A demanding physical activity, as well as other circumstances present in scuba diving, has the greatest load on the cardiovascular function (CV). The mechanisms of CV response during scuba diving are still unclear, but diving-induced oxidative stress and the increase in SIRTs expression could be an important factor in CV adaptation. This review summarizes current knowledge on scuba diving-induced oxidative and CV stress and describes the important roles of SIRTs in the (patho)physiological processes caused by the redox balance disorder.

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Section: Cardiovascular Response To Scuba Divingmentioning

confidence: 85%

Recreational scuba diving: negative or positive effects of oxidative and cardiovascular stress?

2014

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“…Alternatively, the leakage could be related to other factors, as has been observed in endurance athletes with elevated troponin levels but no evidence of myocardial necrosis on magnetic resonance imaging (MRI). 13 …”

Section: Discussionmentioning

confidence: 99%

Prospective Exploratory Analysis of Cardiac Biomarkers and Electrocardiogram Abnormalities in Patients Receiving Thoracic Radiation Therapy with High-Dose Heart Exposure

Gomez

Yusuf

Munsell

et al. 2014

Journal of Thoracic Oncology

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Introduction Acute effects of incidental cardiac irradiation in patients treated for thoracic cancer are not well characterized. We evaluated longitudinal changes in cardiac biomarkers for patients undergoing conformal radiation therapy (RT) with thoracic malignancies with high-dose cardiac exposure. Methods Twenty-five patients enrolled in a prospective trial (February 2009–December 2012) received ≥45 Gy to the thorax, with pretreatment estimates of ≥20 Gy to the heart. Chemotherapy was allowed except for doxorubicin or fluorouracil. Electrocardiographic (ECG), troponin-I (TnI), and brain natriuretic peptide (BNP) measurements were obtained before RT, within 24 hours of the first fraction, at the end of RT, and at first follow-up (1–2 months). These biomarkers were quantified at specific times and changes from baseline were evaluated with paired t tests. Results The median heart dose was 25.9 Gy (range 10.1–35.1 Gy). After the first RT fraction, no changes were noted in ECG or median Tnl or BNP levels; at the end of RT, two patients had elevated TnI and BNP, but neither difference was statistically significant. At first follow-up, TnI had returned to normal but the median BNP remained elevated (P=0.042). BNP did not increase over time in the 18 patients who received only RT. Twelve patients experienced acute ECG changes during RT, which resolved in seven patients by the next measurement. No patients experienced clinically significant RT-related events. Conclusion Increases in BNP and ECG changes were observed during high doses of radiation to the heart. The findings of this pilot study warrant further investigation and validation.

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“…Therefore, it is tempting to suggest that the appearance of cTnI after physical exercise does not reflect a clinically threatening (irreversible) myocardial injury, but rather may reflect a reversible increase in cellular membrane permeability and rapid troponin release from the cytosolic pool post-exercise (Lippi and Plebani 2009). Some authors have suggested that exercise-induced cTn release reflects the activation of cellular cascades that result in cardiac hypertrophy (Scharhag et al 2006). Changes in cellular membrane permeability, subsequent to an increased rate and force of cardiac contraction during endurance exercise, may provide a mechanism by which cytosolic troponin is released into the circulation after exercise.…”

Section: Discussionmentioning

confidence: 99%

The impact of exercise intensity on the release of cardiac biomarkers in marathon runners

et al. 2011

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We sought to determine the influence of exercise intensity on the release of cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in amateur marathon runners. Fourteen runners completed three exercise trials of the same duration but at exercise intensities corresponding to: (a) a competitive marathon [mean ± SD: heart rate 159 ± 7 beat min(-1), finish time 202 ± 14 min]; (b) 95% of individual anaerobic threshold [heart rate 144 ± 6 beat min(-1)] and; (c) 85% of individual anaerobic threshold [heart rate 129 ± 5 beat min(-1)]. cTnI and NT-proBNP were assayed from blood samples collected before, 30 min and 3 h post-exercise for each trial. cTnI and NT-proBNP were not different at baseline before each trial. After exercise at 85% of individual anaerobic threshold cTnI was not significantly elevated. Conversely, cTnI was elevated after exercise at 95% of individual anaerobic threshold (0.016 μg L(-1)) and to an even greater extent after exercise at competition intensity (0.054 μg L(-1)). Peak post-exercise values of NT-proBNP were elevated to a similar extent after all exercise trials (P < 0.05). The upper reference limit for cTnI (0.04 μg L(-1)) was exceeded in six subjects at competition intensity. No data for NT-proBNP surpassed its upper reference limit. Peak post-exercise values for cTnI and NT-proBNP were correlated with their respective baseline values. These data suggest exercise intensity influences the release of cTnI, but not NT-proBNP, and that competitive marathon running intensity is required for cTnI to be elevated over its upper reference limit.

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Reproducibility and clinical significance of exercise-induced increases in cardiac troponins and N-terminal pro brain natriuretic peptide in endurance athletes

Abstract: Due to the missing reproducibilty and evidence of myocardial damage, exercise-induced increases in cardiac troponins may represent a physiologic reaction under special conditions and seem to be without pathological significance in healthy athletes.

Cited by 79 publications

References 34 publications

Recreational scuba diving: negative or positive effects of oxidative and cardiovascular stress?

Recreational scuba diving: negative or positive effects of oxidative and cardiovascular stress?

Prospective Exploratory Analysis of Cardiac Biomarkers and Electrocardiogram Abnormalities in Patients Receiving Thoracic Radiation Therapy with High-Dose Heart Exposure

The impact of exercise intensity on the release of cardiac biomarkers in marathon runners

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