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Changes in cardiac markers including B-natriuretic peptide in runners after the Boston marathon

      In contrast to nonspecific elevations of myoglobin and creatine kinase-MB (CK-MB) in athletes due to exertional rhabdomyolysis of trained skeletal muscle,
      • Siegel A.J.
      • Silverman L.M.
      • Evans W.K.
      Elevated skeletal muscle creatine kinase MB isoenzyme levels in marathon runners.
      ,
      • Thompson G.R.
      Hazards of running a marathon Creatine kinase mb can be raised without myocardial infarction.
      reported increases in cardiospecific troponins after competition may indicate silent injury to the myocardium.
      • Laslett L.
      • Eisenbud E.
      Lack of detection of myocardial injury during competitive races of 100 miles lasting 18 to 30 hours.
      ,
      • Laslett L.
      • Eisenbud E.
      • Lind R.
      Evidence of myocardial injury during prolonged strenuous exercise.
      ,
      • Siegel A.J.
      • Sholar M.
      • Yang J.
      • Dhanak E.
      • Lewandrowski K.B.
      Elevated serum cardiac markers in asymptomatic marathon runners after competition Is the myocardium stunned?.
      ,

      Koller A, Summer P, Moser H. Regular exercise and subclinical myocardial injury during prolonged aerobic exercise. JAMA 1999;282:1816

      ,
      • Rifai N.
      • Douglas P.S.
      • O’Tolle M.
      • Rimm E.
      • Ginsburg G.S.
      Cardiac troponin T and I, electrocardiographic wall motion analyses, and ejection fractions in athletes participating in the Hawaii ironman triathlon.
      ,
      • Cleve P.
      • Boswell T.D.
      • Speedy D.B.
      • Boswell D.R.
      Plasma cardiac troponin concentrations after extreme exercise.
      We therefore undertook serial testing of multiple cardiac markers used to diagnose early- and late-stage myocardial injury in the same group of middle-aged runners before and sequentially after 5 Boston marathons over 4 years. In addition to CK-MB and myoglobin, cardiac troponin I (cTnI) was tested by a qualitative rapid assay in 1997, a high-sensitivity reference method in 1998 to 2000, and a rapid quantitative method to detect acute myocardial infarction (AMI) in 2001 together with cTnT. Selective postrace single-photon emission computed tomography (SPECT) with technetium-99m sestamibi myocardial scintigraphy and B-natriuretic peptide (BNP) levels were used to assess microinfarction and transient left ventricular dysfunction, respectively.
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