Reproducibility and clinical significance of exercise-induced increases in cardiac troponins and N-terminal pro brain natriuretic peptide in endurance athletes
Reproducibility and clinical significance of exercise-induced increases in cardiac troponins and N-terminal pro brain natriuretic peptide in endurance athletes
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DOI：
10.1097/00149831-200606000-00015
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发表时间：
2006-06-01
影响因子：
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通讯作者：
Kindermann, Wilfried
中科院分区：
文献类型：
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作者：
Scharhag, Juergen;Urhausen, Axel;Kindermann, Wilfried
背景心肌肌钙蛋白I和T以及脑利钠肽是血清学上识别心肌坏死和室壁应力升高的公认标准。此外，它们还允许对心血管患者进行风险分层。因此，我们考察了两次标准化耐力运动后心肌肌钙蛋白I、T和N末端脑利钠肽原在两次标准化耐力运动后升高(I，0.08~1.93微克/L；T，0.01~0.56微克/L)的重复性和临床意义。方法对2 0名男性运动员(36 7岁，最大摄氧量：60+/-5ml/min/kg)按随机顺序在运动前、运动后30min和运动后3h分别进行1h和3h的运动试验(运动强度分别为个体无氧阈值的100%和75%)。除了运动前后的超声心动图(包括组织多普勒成像)，在运动3h后进行延迟增强磁共振成像以检测心肌坏死。结果两次运动后心肌肌钙蛋白I均有轻微增加(从0.02mU/L增加到0.03mU/L；P<；0.001)。心肌肌钙蛋白T无明显变化。运动1h和3h后，N末端脑利钠肽原分别增加9和30 ng/L(P<；0.001)。与心肌肌钙蛋白相反，比赛后N末端脑利钠肽原的增加与1小时运动学习(p=0.88)和3 h运动学习(p=0.82)相关。结论由于缺乏重复性和心肌损伤的证据，运动引起的心肌肌钙蛋白升高可能是特殊条件下的一种生理反应，似乎没有病理意义。(C)2006年欧洲心脏病学会。
Background Cardiac troponins I and T and brain natriuretic peptide are the accepted standards to serologically identify myocardial necrosis and elevated wall stress. In addition, they allow risk stratification in cardiovascular patients. The clinical significance of increases in cardiac markers after strenuous endurance exercise in obviously healthy athletes is unclear.Design We therefore examined the reproducibility and clinical significance of exercise-induced increases in cardiac troponins I and T and N-terminal pro brain natriuretic peptide after two standardized endurance exercise trials in healthy endurance athletes with prior competition-induced elevations of cardiac troponins (I, 0.08-1.93 mu g/l; T, 0.01-0.56 mu g/l). Methods Twenty male athletes (36 7 years; V-O2max: 60 +/- 5 ml/min per kg) completed a 1-h and a 3-h exercise study (exercise intensities 100 and 75%, respectively, of the individual anaerobic threshold) on two different days in randomized order to determine cardiac markers before, 30 min and 3h after exercise. In addition to pre- and post-exercise echocardiography including tissue Doppler imaging, delayed enhancement magnetic-resonance-imaging was performed after a 3-h exercise study to detect myocardial necrosis.Results A marginal increase in cardiac troponin I was documented after both exercise trials (from 0.02 to 0.03 mu g/l; P < 0.001). Cardiac troponin T remained without significant changes. N-terminal pro brain natriuretic peptide increased by 9 and 30 ng/l after 1-h and 3-h exercise studies, respectively (P < 0.001). In contrast to cardiac troponins, increases in N-terminal pro brain natriuretic peptide after competition correlated with those after 1-h exercise study (p=0.88) and 3-h exercise-study (p=0.82). No pathologies were demonstrated by echocardiography or delayed-enhancement magnetic resonance imaging.Conclusions 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. (c) 2006 The European Society of Cardiology.