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Effect of the “Race Across The Alps” in elite cyclists on plasma cardiac troponins I and T

2002; Elsevier BV; Volume: 89; Issue: 4 Linguagem: Inglês

10.1016/s0002-9149(01)02280-9

1879-1913

G Neumayr, Rudolf Pfister, Guenther Mitterbauer, Angelika Maurer, Hannes Gaenzer, Wolfgang Sturm, H. Hoertnagl,

Cardiac Arrest and Resuscitation

The cardiac troponins I (cTnI) and T (cTnT) are today’s preferred markers for the diagnosis of myocardial damage. 1 Jaffe A.S Ravkilde J Roberts R Naslund U Apple F.S Galvani M Katus H It’s time for a change to a troponin standard. Circulation. 2000; 102: 1216-1220 Crossref PubMed Scopus (576) Google Scholar Highly specific immunoassays differentiate cardiac and skeletal muscle troponin isoforms. Regarding the virtually negligible cross-reactivity (<0.005 for cTnI; <0.001 for cTnT), any increase of cTnI or cTnT is highly specific for its release from the myocardium, even in the presence of simultaneous skeletal muscle damage. 2 Adams III, J.E Bodor G.S Davila-Roman V.G Delmez J.A Apple F.S Ladenson J.H Jaffe A.S Cardiac troponin I a marker with a high specifity for cardiac injury. Circulation. 1993; 88: 101-106 Crossref PubMed Google Scholar , 3 Müller-Bardorff M Hallermayer K Schroder A Ebert C Borgya A Gerhardt W Remppis A Zehelein J Katus H.A Improved troponin T ELISA specific for cardiac troponin T isoform assay development and analytical and clinical validation. Clin Chem. 1997; 43: 458-466 PubMed Google Scholar , 4 Baum H Braun S Gerhardt W Gilson G Hafner G Müller-Bardorff M Stein W Klein G Ebert C Hallermayer K Katus H.A Multicenter evaluation of a second-generation assay for cardiac troponin T. Clin Chem. 1997; 43: 1877-1884 PubMed Google Scholar Extreme exercise involves a variety of health hazards. Whether these health hazards also include myocardial damage is a controversial issue. 5 Rowe W.J Extraordinary unremitting endurance exercise and permanent injury to normal heart. Lancet. 1992; 340: 712-714 Abstract PubMed Scopus (63) Google Scholar Recently, we found increased levels of cTnI after exercise in healthy “recreational cyclists” who participated in a cycle-touring event as evidence of subclinical exercise-induced myocardial damage. 6 Neumayr G Gaenzer H Pfister R Sturm W Schwarzacher S.P Eibl G Mitterbauer G Hoertnagl H Plasma levels of cardiac troponin I after prolonged strenuous endurance exercise. Am J Cardiol. 2001; 87: 369-371 Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar This finding confirmed other data obtained from heterogeneous groups of athletes who also had moderate increases of cardiac troponins after exercise. 7 Rifai N Douglas P.S O’Toole 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. Am J Cardiol. 1999; 83: 1085-1089 Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar , 8 Whyte G.P George K Sharma S Lumley S Gates P Prasad K McKenna W.J Cardiac fatigue following prolonged endurance exercise of differing distances. Med Sci Sports Exerc. 2000; 32: 1067-1072 Crossref PubMed Scopus (129) Google Scholar , 9 Koller A Summer P Moser H Regular exercise and subclinical myocardial injury during prolonged aerobic exercise. JAMA. 1999; 282 (letter): 19 Crossref PubMed Scopus (29) Google Scholar , 10 Koller A Mair J Mayr M Calzolari C Larue C Puschendorf B Diagnosis of myocardial injury in marathon runners. Ann N Y Acad Sci. 1995; 752 (letter): 234-235 Crossref PubMed Scopus (33) Google Scholar Based on an experimental model of vital exhaustion in rats, it was hypothesized that exercise-induced cardiac injury predominantly occurs in untrained hearts. 11 Chen Y Serfass R.C Mackey-Bojack S.M Kelly K.L Titus J.L Apple F.S Cardiac troponin T alterations in myocardium and serum of rats after stressful, prolonged intense exercise. J Appl Physiol. 2000; 88: 1749-1755 PubMed Google Scholar The analogous speculation for humans was that people who perform physical activity only on modest scale would experience this release of cardiac troponins, and that high-volume regular training could prevent the release of cardiac troponins. 9 Koller A Summer P Moser H Regular exercise and subclinical myocardial injury during prolonged aerobic exercise. JAMA. 1999; 282 (letter): 19 Crossref PubMed Scopus (29) Google Scholar The objective of the present study was to investigate the world’s best ultraendurance cyclists competing in the extraordinary “Race Across The Alps” (RATA) with regard to potential stress-induced myocardial damage. cTnI and cTnT were used as markers of myocardial damage.