1.
Evidence of direct cardiac damage following high-intensity exercise in chronic energy restriction: A case report and literature review.
Baird, MF, Grace, F, Sculthorpe, N, Graham, SM, Fleming, A, Baker, JS
Medicine. 2017;(27):e7030
-
-
Free full text
-
Abstract
RATIONALE Following prolonged endurance events such as marathons, elevated levels of cardiospecific biomarkers are commonly reported. Although transiently raised levels are generally not considered to indicate clinical myocardial damage, comprehension of this phenomenon remains incomplete. The popularity of high-intensity interval training highlights a paucity of research measuring cardiac biomarker response to this type of exercise. This a posteriori case report discusses the elevation of cardiac troponins (cTn) associated with short interval, high-intensity exercise. PATIENT CONCERNS In this case report, an apparently healthy 29-year-old recreationally active female presented clinically raised cardiac troponin I (cTnI) levels (>0.04 ng/mL), after performing high-intensity cycle ergometer sprints. As creatine kinase (CK) is expressed by multiple organs (e.g., skeletal muscle, brain, and myocardium), cTnI assays were performed to determine any changes in total serum CK levels not originating from skeletal muscle damage. DIAGNOSIS A posteriori the individual's daily energy expenditure indicated chronically low-energy availability. Psychometric testing suggested that the individual scored positive for disordered eating, highly for fatigue levels, and low in mental health components. OUTCOMES The current case report provides novel evidence of elevated cTnI occurring as a result of performing short duration, high intensity, cycle ergometer exercise in an individual with self-reported chronically depleted energy balance. A schematic to identify potentially "at risk" individuals is presented. LESSONS Considering this as a case report, results cannot be generalized; however, the main findings suggest that individuals who habitually restrict their calorie intake below their bodies' daily energy requirements, may have elevated biomarkers of exercise induced myocardial stress from performing high-intensity exercise.
2.
Cardiac troponin after percutaneous coronary intervention and 1-year mortality in non-ST-segment elevation acute coronary syndrome using systematic evaluation of biomarker trends.
Tricoci, P, Leonardi, S, White, J, White, HD, Armstrong, PW, Montalescot, G, Giugliano, RP, Gibson, CM, Van de Werf, F, Califf, RM, et al
Journal of the American College of Cardiology. 2013;(3):242-251
Abstract
OBJECTIVES This study sought to review cardiac troponin (cTn) trends during non-ST-segment elevation acute coronary syndrome (NSTE ACS) in patients undergoing percutaneous coronary intervention (PCI) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndromes) and SYNERGY (Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors) studies and to study the relationship between post-PCI cTn and mortality. BACKGROUND The prognostic value of cTn post-PCI is controversial. In patients with NSTE ACS, it is especially difficult to distinguish between cTn elevations due to PCI or index myocardial infarction (MI). METHODS Time and cTn (indexed by upper limit of normal [ULN]) data pairs were plotted for 10,199 patients and independently reviewed by 2 physicians to identify patients in whom post-PCI cTn elevation could be distinguished from that of index MI. Post-PCI cTn peak was identified for each plot, and its relationship with 1-year mortality was evaluated using Cox modeling, correcting for 15 clinical variables from the EARLY ACS 1-year mortality model (including baseline cTn). We used an identical methodology to assess the association between creatine kinase-myocardial band and 1-year mortality. RESULTS Patients with cTn (re-)elevation post-PCI not evaluable were identified and excluded from further analysis (4,198 [41%] with cTn rising prior to PCI; 229 [2%] with missing cTn). Among the remainder (n = 5,772 [57%]), in the multivariable model, peak cTn post-PCI was associated with a 7% increase in mortality (hazard ratio [HR] for 10 × ULN increase: 1.07, 95% confidence interval [CI]: 1.02 to 1.11; p = 0.0038). Peak post-PCI creatine kinase-myocardial band was significantly associated with 1-year mortality (HR for 1 × ULN increase: 1.13, 95% CI: 1.05 to 1.21; p = 0.0013). CONCLUSIONS We used a methodology that differentiated post-PCI cTn (re-)elevation from that of presenting MI in more than one-half of patients with NSTE ACS undergoing PCI. This identified a highly significant relationship between post-PCI cTn and 1-year mortality, with implications for both incorporating a cTn post-PCI MI definition and preventing PCI-related myonecrosis.
3.
Significance of elevated cardiac troponin I in patients with diabetic ketoacidosis.
Abdo, AS, Geraci, SA
Journal of the Mississippi State Medical Association. 2013;(5):127-30
Abstract
BACKGROUND Cardiac troponin I displays significant prognostic value in acute coronary syndromes and in other non-coronary conditions and systemic illnesses. Elevated levels of this biomarker in the setting of diabetic ketoacidosis may also provide useful prognostic information regarding outcome. METHODS A systematic review of the English language medical literature was performed using PubMed. Articles reporting original data on major clinical outcomes on cohorts of patients were included. RESULTS Three reports examining the relationship between cardiac troponin I and clinical outcomes in patients with diabetic ketoacidosis qualified for review. A spectrum of electrolyte and cardiac abnormalities were observed in the studied populations which were more frequent in those with troponin elevations. Short- and long-term outcomes appeared worse for patients with elevated troponin levels, but small study populations and other experimental issues including concurrent diseases which could have confounded the apparent relationship between troponin concentrations and outcome reduced the confidence of the findings. CONCLUSIONS The available literature suggests an association between elevated cardiac-specific troponin I serum concentrations and clinical outcomes among diabetic patients with ketoacidosis, but data are insufficient to draw conclusions at this time. Large prospective observational studies which exclude or control for other conditions which could contribute to troponin release will be needed before the predictive value of this biomarker in ketoacidosis can be reliably defined.
4.
Current trends in diagnostic biomarkers of acute coronary syndrome.
Moe, KT, Wong, P
Annals of the Academy of Medicine, Singapore. 2010;(3):210-5
Abstract
The diagnosis and management of patients with acute coronary syndrome (ACS) have evolved dramatically over the past decade. Biomarkers play an important role in the diagnosis of ACS, especially in unstable angina and non-ST-segment elevation myocardial infarction. Among these, cardiac troponin and creatine kinase appear to be the most sensitive and specific markers of myocardial injury. Recent studies have revealed several novel biomarkers. Elevated levels of C-reactive protein and interleukin-6 are strong independent markers of increased mortality among patients with ACS. However, the ideal biomarkers that offer early detection, risk stratification, selection of therapy, monitoring disease progression, and treatment efficacy remain to be elucidated. This review assesses limitations and contemporary needs for biomarkers in the context of diagnosis of ACS. It also discusses the newly developing technologies for novel biomarkers or novel biomarker protein signatures discovery, and importance of point-of-care testing for future management.