Advertisement

Predisposing Factors and Consequences of Elevated Biomarker Levels in Long-Distance Runners Aged ≥55 Years

Published:September 18, 2009DOI:https://doi.org/10.1016/j.amjcard.2009.06.067
      Cardiac biomarkers play an important role in the diagnosis of cardiovascular disease. Elevated levels can be seen in the context of strenuous exercise. We studied this phenomenon in senior endurance runners. We included 185 participants (61.1 ± 5 years; 29% women) at a 30-km cross-country race who were self-reportedly in excellent health. Before and after the race, the creatinine, N-terminal pro-brain natriuretic peptide (NT-proBNP), and troponin T were analyzed, and participation in the number of previous races and the race duration were recorded. NT-proBNP increased from 53 ng/L (interquartile range 31 to 89) to 121 ng/L (interquartile range 79 to 184) and troponin T from undetectable to 0.01 μg/L (interquartile range 0.01 to 0.04). The independent predictors of a large NT-proBNP increase were (1) greater levels present at baseline, (2) a greater increase in creatinine (both p <0.001), (3) older age (p = 0.01), and (4) a longer race duration (p <0.05). Troponin T elevation was independently predicted by (1) older age (p = 0.01), (2) a greater increase in creatinine, and (3) participation in fewer previous races (both p <0.05). Of the 15 runners with an elevated (>194 ng/L) baseline NT-proBNP level (8.1% of 185), 4 were found to have serious cardiovascular disease (2.2% of whole sample). Of these 4 patients, 1 died from sudden cardiac death within months after the race. In conclusion, biomarker elevation occurs commonly in senior runners. A high baseline NT-proBNP is predictive of a large release during exercise, suggesting that the factors that control the at rest levels also determine its release with exertion. Troponin T elevation was seen in less-experienced participants. A small group of very ill runners were identified by NT-proBNP analysis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sahlen A.
        • Winter R.
        • Lind B.
        • Jacobsen P.H.
        • Stahlberg M.
        • Marklund T.
        • Fux T.
        • Svensson J.
        • Braunschweig F.
        Magnitude, reproducibility, and association with baseline cardiac function of cardiac biomarker release in long-distance runners aged > or =55 years.
        Am J Cardiol. 2008; 102: 218-222
        • Link M.S.
        • Nam III, E.
        Ventricular arrhythmias.
        in: Nam III, E. Salem D.N. Wang P.J. Sudden Cardiac Death in the Athlete. Futura Publishing, Armonk, NY1998: 253-275
        • Epstein S.E.
        • Maron B.J.
        Sudden death and the competitive athlete: perspectives on preparticipation screening studies.
        J Am Coll Cardiol. 1986; 7: 220-230
        • Jokl P.
        • Sethi P.M.
        • Cooper A.J.
        Master's performance in the New York City marathon 1983–1999.
        Br J Sports Med. 2004; 38: 408-412
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • Sutton M.S.
        • Stewart W.J.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Herrmann M.
        • Scharhag J.
        • Miclea M.
        • Urhausen A.
        • Herrmann W.
        • Kindermann W.
        Post-race kinetics of cardiac troponin T and I and N-terminal pro-brain natriuretic peptide in marathon runners.
        Clin Chem. 2003; 49: 831-834
        • Leers M.P.
        • Schepers R.
        • Baumgarten R.
        Effects of a long-distance run on cardiac markers in healthy athletes.
        Clin Chem Lab Med. 2006; 44: 999-1003
        • Neilan T.G.
        • Januzzi J.L.
        • Lee-Lewandrowski E.
        • Ton-Nu T.T.
        • Yoerger D.M.
        • Jassal D.S.
        • Lewandrowski K.B.
        • Siegel A.J.
        • Marshall J.E.
        • Douglas P.S.
        • Lawlor D.
        • Picard M.H.
        • Wood M.J.
        Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon.
        Circulation. 2006; 114: 2325-2333
        • La Gerche A.
        • Connelly K.A.
        • Mooney D.J.
        • MacIsaac A.I.
        • Prior D.L.
        Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise.
        Heart. 2008; 94: 860-866
        • Sahlen A.
        • Rubulis A.
        • Winter R.
        • Jacobsen P.H.
        • Stahlberg M.
        • Tornvall P.
        • Bergfeldt L.
        • Braunschweig F.
        Cardiac fatigue in long-distance runners is associated with ventricular repolarization abnormalities.
        Heart Rhythm. 2009; 6: 512-519
        • La Gerche A.
        • Boyle A.
        • Wilson A.M.
        • Prior D.L.
        No evidence of sustained myocardial injury following an ironman distance triathlon.
        Int J Sports Med. 2004; 25: 45-49
        • Montgomery H.E.
        • Clarkson P.
        • Dollery C.M.
        • Prasad K.
        • Losi M.A.
        • Hemingway H.
        • Statters D.
        • Jubb M.
        • Girvain M.
        • Varnava A.
        • World M.
        • Deanfield J.
        • Talmud P.
        • McEwan J.R.
        • McKenna W.J.
        • Humphries S.
        Association of angiotensin-converting enzyme gene I/D polymorphism with change in left ventricular mass in response to physical training.
        Circulation. 1997; 96: 741-747
        • Suzuki M.
        • Sudoh M.
        • Matsubara S.
        • Kawakami K.
        • Shiota M.
        • Ikawa S.
        Changes in renal blood flow measured by radionuclide angiography following exhausting exercise in humans.
        Eur J Appl Physiol Occup Physiol. 1996; 74: 1-7
        • Hart E.
        • Shave R.
        • Middleton N.
        • George K.
        • Whyte G.
        • Oxborough D.
        Effect of preload augmentation on pulsed wave and tissue Doppler echocardiographic indices of diastolic function after a marathon.
        J Am Soc Echocardiogr. 2007; 20: 1393-1399
        • Fortescue E.B.
        • Shin A.Y.
        • Greenes D.S.
        • Mannix R.C.
        • Agarwal S.
        • Feldman B.J.
        • Shah M.I.
        • Rifai N.
        • Landzberg M.J.
        • Newburger J.W.
        • Almond C.S.
        Cardiac troponin increases among runners in the Boston Marathon.
        Ann Emerg Med. 2007; 49 (143.e1): 137-143
        • Scharhag J.
        • Herrmann M.
        • Urhausen A.
        • Haschke M.
        • Herrmann W.
        • Kindermann W.
        Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise.
        Am Heart J. 2005; 150: 1128-1134
        • Scharhag J.
        • Urhausen A.
        • Schneider G.
        • Herrmann M.
        • Schumacher K.
        • Haschke M.
        • Krieg A.
        • Meyer T.
        • Herrmann W.
        • Kindermann W.
        Reproducibility and clinical significance of exercise-induced increases in cardiac troponins and N-terminal pro brain natriuretic peptide in endurance athletes.
        Eur J Cardiovasc Prev Rehabil. 2006; 13: 388-397
        • Siegel A.J.
        • Lewandrowski K.B.
        • Strauss H.W.
        • Fischman A.J.
        • Yasuda T.
        Normal post-race antimyosin myocardial scintigraphy in asymptomatic marathon runners with elevated serum creatine kinase MB isoenzyme and troponin T levels: evidence against silent myocardial cell necrosis.
        Cardiology. 1995; 86: 451-456
        • Nikitin N.P.
        • Witte K.K.
        • Ingle L.
        • Clark A.L.
        • Farnsworth T.A.
        • Cleland J.G.
        Longitudinal myocardial dysfunction in healthy older subjects as a manifestation of cardiac ageing.
        Age Ageing. 2005; 34: 343-349
        • Vinereanu D.
        • Lim P.O.
        • Frenneaux M.P.
        • Fraser A.G.
        Reduced myocardial velocities of left ventricular long-axis contraction identify both systolic and diastolic heart failure—a comparison with brain natriuretic peptide.
        Eur J Heart Fail. 2005; 7: 512-519
        • Nottin S.
        • Nguyen L.D.
        • Terbah M.
        • Obert P.
        Long-term endurance training does not prevent the age-related decrease in left ventricular relaxation properties.
        Acta Physiol Scand. 2004; 181: 209-215
        • Johnston N.
        • Jernberg T.
        • Lindahl B.
        • Lindback J.
        • Stridsberg M.
        • Larsson A.
        • Venge P.
        • Wallentin L.
        Biochemical indicators of cardiac and renal function in a healthy elderly population.
        Clin Biochem. 2004; 37: 210-216
        • Thompson P.D.
        • Funk E.J.
        • Carleton R.A.
        • Sturner W.Q.
        Incidence of death during jogging in Rhode Island from 1975 through 1980.
        JAMA. 1982; 247: 2535-2538
        • Wang T.J.
        • Larson M.G.
        • Levy D.
        • Benjamin E.J.
        • Leip E.P.
        • Omland T.
        • Wolf P.A.
        • Vasan R.S.
        Plasma natriuretic peptide levels and the risk of cardiovascular events and death.
        N Engl J Med. 2004; 350: 655-663
        • Devaraj S.
        • Singh U.
        • Jialal I.
        The evolving role of C-reactive protein in atherothrombosis.
        Clin Chem. 2009; 55: 229-238