Abstract
The study of cardiac response to strenuous and continuous exercise is crucial to understanding the physiology of endurance. N-terminal proB-type natriuretic peptide (NT-proBNP) is a potential marker for monitoring myocardial wall stress, and troponins (TnT and TnI) are widely used in the diagnosis of cardiac ischemia and infarction. Strenuous exercise may generate transitory ischemia, myocardial stress, and diastolic left ventricular dysfunction, inducing the increased production of both these biomarkers. We measured changes in NT-proBNP and TnT in elite cyclists during a 3-week stage race, a model of strenuous exercise. The study population was 9 professional cyclists participating in the 2011 Giro d'Italia. Pre-analytical and analytical phases scrupulously followed official recommendations. Anthropometric data, net energy expenditure and cardiac indexes (rate, diastolic and systolic blood pressure) were recorded. Blood samples were drawn pre-race (day - 1) and at days 12 and 22; NT-proBNP and highly sensitive-troponin (Hs-TnT) concentrations were assayed and corrected for plasma volume changes. Body-mass index decreased and energy expenditure increased by 52% during the race. NT-proBNP concentrations increased [day -1:23.52 ng/L (9.67-34.33); day 12:63.46 ng/L (22.15-93.31); P = 0.039; day 22:89.26 ng/L (34.66-129.78) vs.day -1; P < 0.001] and correlated with heart rate (r = -0.51; P = 0.006), systolic pressure (r = 0.39; P = 0.046) and energy expenditure (r = 0.70; P < 0.001). TnT concentrations did not vary, but a widened TnT amplitude distribution was observed. Increases in NT-proBNP correlated with higher energy expenditure over a 3-week cycling stage race, possibly indicating myocardial stress.
Highlights
The study of cardiac response to strenuous and continuous exercise is crucial to understanding the physiology of endurance
Body-mass index decreased and energy expenditure increased by 52% during the race
Increases in NT-proBNP correlated with higher energy expenditure over a 3-week cycling stage race, possibly indicating myocardial stress
Summary
The study of cardiac response to strenuous and continuous exercise is crucial to understanding the physiology of endurance. N-terminal proB-type natriuretic peptide (NT-proBNP) is a potential marker for monitoring myocardial wall stress, and troponins (TnT and TnI) are widely used in the diagnosis of cardiac ischemia and infarction. Strenuous exercise may generate transitory ischemia, myocardial stress, and diastolic left ventricular dysfunction, inducing the increased production of both these biomarkers. The 76 amminoacid N-terminal proB-type natriuretic peptide (NT-proBNP) has been proposed as a marker for evaluating and monitoring cardiac abnormalities characterized by myocardial wall stress [1]. Strenuous exercise may generate transitory ischemia, myocardial stress, and diastolic left ventricular dysfunction, resulting in increased production of NT-proBNP suggestive of incipient heart disease. The rationale for the use of NT-proBNP, instead of mature BNP, as marker for cardiac dysfunction resides in their different half-life (90-120 versus 18 min) [8]. The finding that NT-proBNP, but not intact BNP is augmented after endurance sport performance [9] is a consequence of the different life spans of the molecules
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