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Left Ventricular Function and Cardiac Biomarker Release—The Influence of Exercise Intensity, Duration and Mode: A Systematic Review and Meta-Analysis

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Abstract

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.

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Authors and Affiliations

  1. School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1QU, UK

    J. A. Donaldson, J. D. Wiles, D. A. Coleman & J. M. O’Driscoll

  2. Cardiology Clinical and Academic Group, St George’s University of London, London, UK

    M. Papadakis

  3. Department of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, UK

    R. Sharma & J. M. O’Driscoll

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  1. J. A. Donaldson
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Contributions

JAD, JDW, DAC, MP, RS and JMO’D contributed to the conception and design of the study. JAD, JDW and JMO’D contributed to the development of the search strategy. JAD and JMO’D conducted the systematic review. JAD, JDW and JMO’D completed the acquisition of data. JAD, JDW and JMO’D performed the data analysis. All authors assisted with the interpretation. JAD, JDW and JMO’D were the principal writers of the manuscript. All authors contributed to the drafting and revision of the final article. All authors approved the final submitted version of the manuscript.

Corresponding author

Correspondence to J. M. O’Driscoll.

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Conflict of interest

James Donaldson, Jonathan Wiles, Damian Coleman, Michael Papadakis, Rajan Sharma, and Jamie O’Driscoll declare that they have no competing interests.

Funding

No financial support was received for the conduct of this study or preparation of this manuscript.

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The need for ethical approval for this study was waived as it used previously published, publicly available data.

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Not applicable.

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All data supporting the results in this manuscript are available within the results sections or supplementary data files of the cited articles.

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Donaldson, J.A., Wiles, J.D., Coleman, D.A. et al. Left Ventricular Function and Cardiac Biomarker Release—The Influence of Exercise Intensity, Duration and Mode: A Systematic Review and Meta-Analysis. Sports Med 49, 1275–1289 (2019). https://doi.org/10.1007/s40279-019-01142-5

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