Raised troponin T and echocardiographic abnormalities after prolonged strenuous exercise—the Australian Ironman Triathlon (original) (raw)
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Postexercise Left Ventricular Function and cTnT in Recreational Marathon Runners
Medicine & Science in Sports & Exercise, 2004
Purpose: To assess the impact of prolonged exercise on left ventricular (LV) function and the appearance of cardiac troponin T (cTnT) in older and recreational athletes. Methods: Heart rate (HR), blood pressures, and cTnT were recorded in 35 subjects (age range 22-57 yr, finishing time 157-341 min) pre-and postrace. Echocardiograms (N ϭ 26) assessed stroke volume (SV), ejection fraction (EF), sBP/LV end-systolic volume (sBP/ESV), diastolic filling (E:A ratio) as well as preload (LV internal dimension at end-diastole [LVIDd]) and afterload (LV wall stress). HR and core temperature were recorded in-event. Prepost changes in LV function were analyzed by repeated measures t-test. Delta scores for LV function and cTnT data were correlated with each other, age, finishing time, alterations in loading, and in-event data. Results: SV was significantly decreased postrace (109 Ϯ 31 vs 85 Ϯ 25 mL, P Ͻ 0.05) likely due to a significant decrease in LVIDd (5.3 Ϯ 0.4 vs 4.9 Ϯ 0.5 cm, P Ͻ 0.05; r ϭ 0.80, P Ͻ 0.05). LV wall stress was unchanged postrace (90 Ϯ 25 vs 89 Ϯ 27 g•cm Ϫ2 , P Ͼ 0.05). EF (70 Ϯ 12 vs.70 Ϯ 10%, P Ͼ 0.05) and sBP/ESV (3.7 Ϯ 2.9 vs 4.0 Ϯ 2.0, P Ͼ 0.05) did not change prepost race and were not related to age or finishing time (P Ͼ 0.05). E:A ratio was significantly reduced postrace (1.73 Ϯ 0.38 vs 1.41 Ϯ 0.25, P Ͻ 0.05) and could not be explained by an increased HR (56 Ϯ 9 vs 84 Ϯ 10, P Ͻ 0.05; r ϭ 0.08, P Ͼ 0.05), a reduced LVIDd (r ϭ 0.11, P Ͼ 0.05), age, finishing time, or in-event data. Postrace 26/33 subjects presented cTnT values in the range 0.024-0.080 g•L Ϫ1 that were not related to changes in LV function, loading, age, finishing time, or in-event data. Conclusion: No evidence of load-independent depression in LV systolic function was reported. Changes in cTnT and E:A were not related, and their etiology is uncertain.
Medicine & Science in Sports & Exercise, 2008
Objective We performed a systematic review, meta-analysis and meta-regression of exercise studies that sought to determine the relationship between cardiac troponin (cTn) and left ventricular (LV) function. The second objective was to determine how study-level and exercise factors influenced the variation in the body of literature. Data sources A systematic search of Pubmed Central, Science Direct, SPORTDISCUS and MEDLINE databases. Eligibility criteria Original research articles published between 1997 and 2018 involving > 30 mins of continuous exercise, measuring cardiac troponin event rates and either LV ejection fraction (LVEF) or the ratio of the peak early (E) to peak late (A) filling velocity (E/A ratio). Design Random-effects meta-analyses and meta-regressions with four a priori determined covariates (age, exercise heart rate [HR], duration, mass). Registration The systematic search strategy was registered on the PROSPERO database (CRD42018102176). Results Pooled cTn event rates were evident in 45.6% of participants (95% confidence interval (CI) 33.6-58.2); however, the overall effect was non-significant (P > 0.05). There were significant (P < 0.05) reductions in E/A ratio of − 0.38 (SMD = − 1.2, 95% CI − 1.4 to − 1.0), and LVEF of − 2.02% (SMD = − 0.38, 95% CI − 0.7 to − 0.1) pre-to post-exercise. Increased exercise HR was a significant predictor of troponin release and E/A ratio. Participant age was negatively associated with cTn release. There was a significant negative association between E/A ratio with increased rates of cTn release (P < 0.05). Conclusions High levels of statistical heterogeneity and methodological variability exist in the majority of EICF studies. Our findings show that exercise intensity and age are the most powerful determinants of cTn release. Diastolic function is influenced by exercise HR and cTn release, which implies that exercise bouts at high intensities are enough to elicit cTn release and reduce LV diastolic function. Future EICF studies should (1) utilise specific echocardiographic techniques such as myocardial speckle tracking, (2) ensure participants are euhydrated during post-exercise measurements, and (3) repeat measures in the hours following exercise to assess symptom progression or recovery. It is also recommended to further explore the relationship between aging, training history, and exercise intensity on cTn release and functional changes.
Clinical Research in Cardiology, 2010
Background Endurance exercise is frequently associated with cardiac troponin (cTn) concentrations, otherwise corresponding to minor myocardial infarction. However, research on the underlying mechanisms has been limited because of assay restraints in the low concentration range. Methods and results Using the pre-commercial, highly sensitive hs-cTnT assay, cTnT concentrations were measured in samples from recreational runners obtained before and after running 5 km (trained, n = 43/untrained, n = 122), 15 km (n = 38), 21 km (n = 10), and 42 km (n = 85) (all trained). The percentage of runners with elevated cTnT concentrations after the run increased with running distance (0, 11, 13, 40, and 86%), in contrast to NT-proBNP (2, 7, 0, 0, 5). Median (IQR) cTnT post-run concentrations were 0.004 lg/L (0.003), 0.006 lg/L (0.008), 0.010 lg/L (0.006), 0.014 lg/L (0.019), and 0.030 lg/L (0.029), respectively. Conclusions We found, using a novel hs-cTnT assay, the distance of recreational competitive running to be positively related to asymptomatic increases in cTnT post-run concentrations. In contrast, NT-proBNP showed no increase. In addition, the data indicated that a relatively short running distance of 5 km resulted in cTnT release of untrained participants, in contrast to trained participants, which underlines the necessity of sufficient training. Further effort is needed to clarify the significance of exerciseinduced cardiac biomarker elevations.
Endurance Sport and “Cardiac Injury”: A Prospective Study of Recreational Ironman Athletes
International Journal of Environmental Research and Public Health, 2014
Background: Participation in triathlon competitions has increased in recent years. Many studies have described left or right ventricular injury in endurance athletes. The goal of this study was to examine the right and left ventricular cardiac structures and function and dynamic cardio-pulmonary performance in a large cohort of middle-and long-distance triathletes. Methods: 87 triathletes (54 male and 33 female) were examined using spiroergometry and echocardiography. The inclusion criterion was participation in at least one middle-or long distance triathlon. Results: Male triathletes showed a maximum oxygen absorption of 58.1 ± 8.6 mL/min/kg (female triathletes 52.8 ± 5.7 mL/min/kg), maximum ergometer performance of 347.8 ± 49.9 W (female triathletes 264.5 ± 26.1 W). Left ventricular ejection fraction (EF) was normal (male triathletes EF: 61.9% ± 3%, female triathletes EF: 63.0% ± 2.7%) and systolic right ventricular area change fraction (RV AFC%) showed normal values (males RV AFC%: 33.5% ± 2.2%, females 32.2% ± 2.8%). Doppler indices of diastolic function were normal in both groups. With respect to the echocardiographic readings the left ventricular mass for males and females were 217.7 ± 41.6 g and 145.9 ± 31.3 g, respectively. The relative wall thickness for males was 0.50 ± 0.07, whereas it was 0.47 ± 0.09 for females. The probability of left ventricular mass >220 g increased with higher blood pressure during exercise (OR: 1.027, CI 1.002-1.052, p = 0.034) or with higher training volume (OR: 1.23, CI 1.04-1.47, p = 0.019). Conclusions: Right or left ventricular dysfunction could not be found, although the maximal participation in triathlon competitions was 29 years. A left ventricular mass
Altered Cardiac Function and Minimal Cardiac Damage during Prolonged Exercise
Medicine & Science in Sports & Exercise, 2004
The purpose of the present study was to examine markers of cardiac function and cardiac damage during a simulated half-ironman triathlon in highly trained athletes. Methods: Nine highly trained male triathletes volunteered for the study (mean Ϯ SD; age: 33 Ϯ 3 yr; height: 1.8 Ϯ 0.1 m; body mass: 77.7 Ϯ 3.2 kg). The subjects completed a half-ironman triathlon; 1.9-km swim in an indoor 20-m pool, followed by a laboratory-based 90-km cycle and 21.1-km run. Venous blood samples were drawn and echocardiographic assessment completed before the start of exercise, immediately after each stage, and 24 h postexercise. Serum was analyzed for total creatine kinase activity (CK), creatine kinase isoenzyme MB mass (CK-MB mass ), and cardiac troponin T (cTnT). Left ventricular systolic (stroke volume, and systolic blood pressure/end systolic volume ratio (SBP/ESV)) and diastolic (ratio of early [E] to late [A], ventricular filling E:A) measurements were derived from echocardiographic assessment. Results: The mean completion time of the half-ironman triathlon was 301 Ϯ 28 min. Left ventricular contractility (SBP/ESV) was significantly reduced after the half-ironman triathlon (P Ͻ 0.05). A significant reduction in E:A was observed after the run phase of the half-ironman triathlon (P Ͻ 0.05). Significant increases in CK and CK-MB mass were observed during and after the half-ironman triathlon (P Ͻ 0.05), and cTnT was elevated in four subjects over the course of the half-ironman triathlon. Conclusions: The physiologic stress imposed by the half-ironman triathlon resulted in a reduced left ventricular contractility and altered diastolic filling, coupled with minimal cardiac damage in a number of highly trained male triathletes. The mechanisms behind such altered cardiac function and cardiac damage after prolonged exercise are yet to be elucidated.
Serum cardiac troponin T in adolescent runners: Effects of exercise intensity and duration
International Journal of Sports Medicine, 2009
The purpose of this study was to evaluate the interactive effects of exercise duration and intensity on the elevation of serum cardiac troponin T (cTnT) in trained adolescent athletes following prolonged exercise in a laboratory-based setting. Thirteen male adolescent runners (mean age 14.8+/-1.6 year) performed two 45-min and two 90-min constant-load treadmill runs with intensities set at the running speeds that corresponded to either 80% or 100% ventilatory threshold (Th(vent)): 80%Th(vent)45 min, 80%Th(vent)90 min, 100%Th(vent)45 min and 100%Th(vent)90 min. Serum cTnT was assessed pre and post exercise. In the 100%Th(vent)45 min trial, the post-exercise serum cTnT level [(Median) 0.015 ng x ml(-1); (Range)<0.01-0.375 ng x ml(-1)] was greater than that of the 80%Th(vent)45 min (undetectable cTnT) and 80%Th(vent)90 min (detectable cTnT in two subjects, 0.021 and 0.133 ng x ml(-1)) trials (P<0.01). The serum cTnT level was further increased in the 100%Th(vent)90 min trial [(Median) 0.063 ng x ml(-1); (Range)<0.01-0.417 ng x ml(-1)] when the treadmill run was sustained for an additional 45 min (P<0.05). Similar changes were observed in the cTnT positive rate in subjects. These findings suggest that exercise duration and intensity are essential factors in eliciting cTnT release interactively following an endurance exercise. Nevertheless, exercise intensity compared to duration appears to cause a more pronounced increase in cTnT levels.
Exercise-Induced Cardiac Troponin T Release
Medicine & Science in Sports & Exercise, 2007
Cardiac troponin T (cTnT) is a highly specific marker of myocardial damage and used clinically in the diagnosis of acute myocardial infarction (AMI). Release of cTnT has been demonstrated in several small studies after endurance exercise. The purpose of this study was to explore, using a meta-analytic approach, the incidence of postexercise cTnT release after endurance exercise. Methods: Articles identified via Pubmed, SportDiscus, and Embase (1997-2006) searches using the key words cardiac troponin T, cTnT, cardiac biomarkers, and exercise; a search of bibliographies; and consultation with experts in the field were entered into a random-effects metaanalysis. We identified 26 relevant studies (1120 cases). Age, gender, and body mass of participants, as well as exercise mode and duration, were explored as possible moderator variables with meta-regressions. Results: Postexercise cTnT levels exceeded the assay detection limit in 47% of participants (95% CI = 39-56%). The detection of postexercise cTnT after cycling events was approximately half that of running events (27 vs 52%, P = 0.042). The detection of postexercise cTnT decreased slightly as event duration increased (P = 0.022) and mean body mass decreased (P = 0.0033). Postexercise detection of cTnT was not affected by age (P = 0.309) and was only slightly higher for studies with more males in the sample (P = 0.028). Conclusions: Exercise-induced cTnT release is apparent in almost half of the endurance athletes who have been studied to date. Relatively heavy individuals competing in shorter endurance events, primarily running marathons, are slightly more likely to demonstrate elevated cTnT postexercise than other athletes. These data are useful for clinicians evaluating athletes with cTnT elevations after competitive endurance exercise events.
Impact of marathon running on cardiac structure and function in recreational runners
Clinical Science, 2005
The present study examined the relationship between LV (left ventricular) function, markers of cardiac-specific damage and markers of oxidative stress in recreational runners following a marathon. Runners (n = 52; 43 male and nine female; age, 35 + − 10 years; height, 1.74 + − 0.08 m; body mass, 75.9 + − 8.9 kg) were assessed pre-and immediately post-marathon. LV function was assessed using standard M-mode two-dimensional Doppler echocardiography and TDI (tissue-Doppler imaging) echocardiography. Serum was analysed for cTnT (cardiac troponin-T), TEAC (Trolox equivalent antioxidant capacity; a measure of total antioxidant capacity), MDA (malondealdehyde) and 4-HNE (4-hydroxynonenal). A strong relationship was observed between standard and TDI echocardiography for all functional measures. Diastolic function was altered postmarathon characterized by a reduction in E (peak early diastolic filling: 0.79 + − 0.11 compared with 0.64 + − 0.16 cm/s; P < 0.001), an increase in A (peak late diastolic filling: 0.48 + − 0.11 compared with 0.60 + − 0.12 cm/s; P < 0.001) and a resultant decrease in E/A (ratio of E to A; 1.71 + − 0.48 compared with 1.10 + − 0.31; P < 0.001). Ejection fraction remained unchanged post-marathon. Thirtytwo runners presented with cTnT values above the lower limit of detection for the assay (0.01 µg/l), and 20 runners presented post-marathon with cTnT values above the acute myocardial infarction cut-off value (0.05 µg/l). No significant correlations were observed between cTnT and any functional measurements. MDA (2.90 + − 1.58 compared with 3.59 + − 1.47 µmol/l) and TEAC (1.80 + − 0.12 compared with 1.89 + − 0.21 mmol/l) were significantly increased post-marathon, but were unrelated to changes in function or cTnT. In conclusion, the present study demonstrated a reduction in diastolic function and widespread evidence of minimal cardiac damage following a marathon in recreational runners. The mechanism(s) underpinning the altered function and appearance of cTnT appear unrelated to reactive oxygen species.
British Journal of Sports Medicine, 2011
Objectives Seventeen male participants (mean (SD) (range): age 33.5 (6.5) years (46-26 years), body mass 80 (9.2) kg (100-63 kg), height 1.81 (0.06) m (1.93-1.70 m)) ran a marathon to investigate the relationship between systolic function (using cardiac magnetic resonance (CMR)) and diastolic function (using echocardiography) against biomarkers of cardiac damage. Methods Echocardiographic and cardiac troponin I (cTnI)/N-terminal pro-B-type natriuretic peptide (NTproBNP) data were collected 24 h premarathon, immediately postmarathon and 6 h postmarathon. CMR data were collected 24 h premarathon and at 6 h postmarathon. Results Body mass was signifi cantly reduced postmarathon (80 (9.2) vs 78.8 (8.6) kg; p<0.001). There was a signifi cant E/A reduction postmarathon (1.11 (0.34) vs 1.72 (0.44); p<0.05) that remained depressed 6 h postmarathon (1.49 (0.43); p<0.05). CMR demonstrated left ventricular end-diastolic and end-systolic volumes were reduced postmarathon, with a preserved stroke volume. Left ventricular ejection fraction 6 h postmarathon significantly increased (64.4% (4.2%) vs 67.4% (5%); p<0.05). There were signifi cant elevations in cTnI (0.00 vs 0.04 (0.03) µg/l; p<0.05) and NTproBNP (37.4 (24.15) ng/l vs 59.34 (43.3) ng/l; p<0.05) immediately postmarathon. Eight runners had cTnI elevations immediately postmarathon above acute myocardial infarction cutoff levels (≥0.03 µg/l). No correlations between cTnI/NTproBNP and measures of diastolic function (E, A, E/A, isovolumic relaxation time, E deceleration time and E/E′) or measures of systolic function (stroke volume or ejection fraction) were observed immediately postmarathon or 6 h postmarathon. Conclusions Biomarkers of cardiac damage after prolonged exercise are not associated with either systolic or diastolic functional measures.