Abstract
Background: The leading mechanisms responsible for the most prevalent and serious cardiac injuries include myocardiocyte stretch, myocardiocyte necrosis and cardiac fibrosis, which can now be reliably mirrored by measurement of natriuretic peptides, cardiospecific troponins and galectin-3, respectively. Although a large amount of knowledge has been gathered about the behavior and clinical significance of these biomarkers in patients with cardiac disorders, less information is available on their biology in paraphysiological conditions, including high-intensity endurance exercise.
Methods: The study population consisted of 18 trained athletes, who performed a 60-km ultramarathon run. Blood was collected before the run (i.e., “baseline”) and immediately after the end of the ultramarathon (“post-marathon”) for measurement of serum high-sensitivity troponin I (TnI), NT-proBNP and galectin-3.
Results: The concentration of all biomarkers measured in the post-marathon samples was remarkably increased as compared with the values obtained on baseline specimens. In particular, the median increase was 3.3 for TnI, 3.5 for NT-proBNP and 2.4 for galectin-3, respectively. The frequency of values exceeding the diagnostic threshold did not differ at baseline and after the ultramarathon for TnI (6% vs. 25%; p=0.15), instead was significantly increased for NT-proBNP (0% vs. 28%; p=0.016) and galectin-3 (0% vs. 67%; p<0.001). No significant correlation was found among the increase of any of the three biomarkers.
Conclusions: The results of this study demonstrate that high-intensity endurance exercise is associated with biochemical abnormalities that may reflect adverse consequences on cardiac structure and biology.
References
1. Lippi G, Plebani M. Biomarker research and leading causes of death worldwide: a rather feeble relationship. Clin Chem Lab Med 2013;51:1691–3.10.1515/cclm-2013-0210Search in Google Scholar PubMed
2. van Kimmenade RR, Januzzi JL Jr. Emerging biomarkers in heart failure. Clin Chem 2012;58:127–38.10.1373/clinchem.2011.165720Search in Google Scholar PubMed
3. Lackner KJ. Laboratory diagnostics of myocardial infarction – troponins and beyond. Clin Chem Lab Med 2013;51:83–9.10.1515/cclm-2012-0572Search in Google Scholar PubMed
4. Lippi G, Franchini M, Cervellin G. Diagnosis and management of ischemic heart disease. Semin Thromb Hemost 2013;39:202–13.10.1055/s-0032-1333543Search in Google Scholar PubMed
5. Lippi G, Montagnana M, Aloe R, Cervellin G. Highly sensitive troponin immunoassays: navigating between the Scylla and Charybdis. Adv Clin Chem 2012;58:1–29.10.1016/B978-0-12-394383-5.00007-2Search in Google Scholar
6. Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE, et al. ACCF/AHA Task Force members. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2013. Available from doi:10.1016/j.jacc.2013.05.019. First published online: 5 June 2013 [Epub ahead of print].Search in Google Scholar
7. Mastandrea P. The diagnostic utility of brain natriuretic peptide in heart failure patients presenting with acute dyspnea: a meta-analysis. Clin Chem Lab Med 2013;51:1155–65.10.1515/cclm-2012-0503Search in Google Scholar PubMed
8. Cheng JM, Akkerhuis KM, Battes LC, van Vark LC, Hillege HL, Paulus WJ, et al. Biomarkers of heart failure with normal ejection fraction: a systematic review. Eur J Heart Fail 2013. Available from doi: 10.1093/eurjhf/hft106. First published online: 11 July 2013 [Epub ahead of print].10.1093/eurjhf/hft106Search in Google Scholar PubMed
9. Chen K, Jiang RJ, Wang CQ, Yin ZF, Fan YQ, Cao JT, et al. Predictive value of plasma galectin-3 in patients with chronic heart failure. Eur Rev Med Pharmacol Sci 2013;17:1005–11.Search in Google Scholar
10. Gaggin HK, Januzzi JL Jr. Biomarkers and diagnostics in heart failure. Biochim Biophys Acta 2013. Available from doi: 10.1016/j.bbadis.2012.12.014. First published online: 9 Jan 2013 [Epub ahead of print].Search in Google Scholar
11. Lippi G, Banfi G, Botrè F, de la Torre X, De Vita F, Gomez-Cabrera MC, et al. Laboratory medicine and sports: between Scylla and Charybdis. Clin Chem Lab Med 2012;50:1309–16.10.1515/cclm-2012-0062Search in Google Scholar PubMed
12. Kavsak PA, MacRae AR, Yerna MJ, Jaffe AS. Analytic and clinical utility of a next-generation, highly sensitive cardiac troponin I assay for early detection of myocardial injury. Clin Chem 2009;55:573–7.10.1373/clinchem.2008.116020Search in Google Scholar PubMed
13. Lippi G, Margapoti R, Aloe R, Cervellin G. Highly-sensitive troponin I in patients admitted to the emergency room with acute infections. Eur J Intern Med 2013;24:e57–8.10.1016/j.ejim.2013.01.019Search in Google Scholar PubMed
14. Prontera C, Zucchelli GC, Vittorini S, Storti S, Emdin M, Clerico A. Comparison between analytical performances of polyclonal and monoclonal electrochemiluminescence immunoassays for NT-proBNP. Clin Chim Acta 2009;400:70–3.10.1016/j.cca.2008.10.011Search in Google Scholar PubMed
15. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Committee for practice guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012;14:803–69.Search in Google Scholar
16. van der Velde AR, Gullestad L, Ueland T, Aukrust P, Guo Y, Adourian A, et al. Prognostic value of changes in galectin-3 levels over time in patients with heart failure: data from CORONA and COACH. Circ Heart Fail 2013;6:219–26.10.1161/CIRCHEARTFAILURE.112.000129Search in Google Scholar PubMed
17. Di Somma S, Navarin S, Giordano S, Spadini F, Lippi G, Cervellin G, et al. The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure. Clin Chem Lab Med 2012;50:2093–105.10.1515/cclm-2012-0289Search in Google Scholar PubMed
18. Lippi G, Cavazza M, Peracino A, Tubaro M, Nechita A, Ballarino P, et al. Ischemic heart disease in the emergency room: state of the art, innovation and research. Emerg Care J 2013;9:e7. Available from doi: 10.4081/ecj.2013.e7 [Epub ahead of print].10.4081/ecj.2013.e7Search in Google Scholar
19. Lippi G, Cervellin G, Banfi G, Plebani M. Cardiac troponins and physical exercise. It′s time to make a point. Biochem Med (Zagreb) 2011;21:55–62.10.11613/BM.2011.012Search in Google Scholar PubMed
20. Lippi G, Banfi G. Exercise-related increase of cardiac troponin release in sports: an apparent paradox finally elucidated? Clin Chim Acta 2010;411:610–1.10.1016/j.cca.2010.01.009Search in Google Scholar PubMed
21. Reichlin T, Schindler C, Drexler B, Twerenbold R, Reiter M, Zellweger C, et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 2012;172:1211–8.10.1001/archinternmed.2012.3698Search in Google Scholar PubMed
22. Lippi G, Schena F, Salvagno GL, Montagnana M, Gelati M, Tarperi C, et al. Influence of a half-marathon run on NT-proBNP and troponin T. Clin Lab 2008;54:251–4.Search in Google Scholar
23. de Boer RA, Yu L, van Veldhuisen DJ. Galectin-3 in cardiac remodeling and heart failure. Curr Heart Fail Rep 2010;7:1–8.10.1007/s11897-010-0004-xSearch in Google Scholar PubMed PubMed Central
24. Sharma UC, Pokharel S, van Brakel TJ, van Berlo JH, Cleutjens JP, Schroen B, et al. Galectin-3 marks activated macrophages in failure-prone hypertrophied hearts and contributes to cardiac dysfunction. Circulation 2004;110:3121–8.10.1161/01.CIR.0000147181.65298.4DSearch in Google Scholar PubMed
25. Liu YH, D′Ambrosio M, Liao TD, Peng H, Rhaleb NE, Sharma U, et al. N-acetyl-seryl-aspartyl-lysyl-proline prevents cardiac remodeling and dysfunction induced by galectin-3, a mammalian adhesion/growth-regulatory lectin. Am J Physiol Heart Circ Physiol 2009;296:H404–12.10.1152/ajpheart.00747.2008Search in Google Scholar PubMed PubMed Central
26. de Boer RA, Edelmann F, Cohen-Solal A, Mamas MA, Maisel A, Pieske B. Galectin-3 in heart failure with preserved ejection fraction. Eur J Heart Fail 2013. Available from doi: 10.1093/eurjhf/hft077. First published online: 5 May 2013 [Epub ahead of print].10.1093/eurjhf/hft077Search in Google Scholar PubMed
27. de Boer RA, Lok DJ, Jaarsma T, van der Meer P, Voors AA, Hillege HL, et al. Predictive value of plasma galectin-3 levels in heart failure with reduced and preserved ejection fraction. Ann Med 2011;43:60–8.10.3109/07853890.2010.538080Search in Google Scholar PubMed PubMed Central
28. Wilson M, O′Hanlon R, Basavarajaiah S, George K, Green D, Ainslie P, et al. Cardiovascular function and the veteran athlete. Eur J Appl Physiol 2010;110:459–78.10.1007/s00421-010-1534-3Search in Google Scholar PubMed
©2014 by Walter de Gruyter Berlin Boston
