Clinical significance of cardiac damage and changes in function after exercise.
Clinical significance of cardiac damage and changes in function after exercise.
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DOI：
10.1249/mss.0b013e318172cefd
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发表时间：
2008-08
影响因子：
4.1
通讯作者：
G. Whyte
中科院分区：
文献类型：
--
作者：
G. Whyte
急性发作的超耐力运动可能导致心肌细胞损伤的生物标志物的出现和左心室功能的短暂性降低。这些变化的临床意义尚不完全清楚。似乎有两个相互矛盾的问题需要解决。首先，长时间的耐力运动是否会产生一定程度的心脏压力和/或损害，从而在短期或长期内对心脏健康产生有害后果。其次，很明显有必要教育那些负责耐力运动员医疗保健的人，让他们了解运动后心功能短暂下降和cTnT/cTnI出现的可能性。心脏肌钙蛋白的轻微升高在精英和休闲运动员的耐力运动后是常见的，并可能与运动相关的崩溃一起发生。心肌损伤的误诊和随后的管理不善可能会给运动员带来不必要的昂贵和心理伤害。长时间运动后心肌损伤的诊断应根据所有可获得的信息，而不仅仅是血液检查。慢性暴露于耐力运动的临床意义尚不清楚。心肌纤维化的发展被认为是长期暴露于重复性耐力运动的长期结果，并与在动物模型中观察到的运动诱导的炎症过程有关。这一假设得到了有限数量的研究的支持，这些研究报道了运动员的死后研究和资深运动员中复杂心律失常的患病率增加。考虑到运动与死亡率和发病率之间的明确联系，在没有进一步详细工作的情况下，推广这一假设需要谨慎。然而，假设运动量和心脏健康之间存在线性关系似乎是错误的。
Acute bouts of ultraendurance exercise may result in the appearance of biomarkers of cardiac cell damage and a transient reduction in left ventricular function. The clinical significance of these changes is not fully understood. There seems to be two competing issues to be resolved. First, could prolonged endurance exercise produce a degree of cardiac stress and/or damage that results, during the short or long term, in deleterious consequences for cardiac health. Second, there is a clear need to educate those responsible for the medical care of endurance athletes about the possibility of a transient reduction in cardiac function and the appearance of cTnT/cTnI after an exercise. Minor elevations in cardiac troponins are commonplace after an endurance exercise in elite and recreational athletes and may occur alongside exercise-associated collapse. Misdiagnosis of myocardial injury and subsequent mismanagement can be unnecessarily expensive and psychologically damaging to the athlete. Diagnosis of myocardial injury after prolonged exercise should be made on the basis of all available information and not blood tests alone. The clinical significance of chronic exposure to endurance exercise is unknown. The development of myocardial fibrosis has been suggested as a long-term outcome to chronic exposure to repetitive bouts of endurance exercise and has been linked to an exercise-induced inflammatory process observed in an animal model. This hypothesis is supported by a limited number of studies reporting postmortem studies in athletes and an increased prevalence of complex arrhythmia in veteran athletes. Care is warranted in promoting this hypothesis without further detailed work, given the unequivocal link between exercise and mortality and morbidity. It would seem erroneous, however, to assume that a linear relationship exists between exercise volume and cardiac health.