High-Sensitivity Cardiac Troponin I and T Response Following Strenuous Activity is Attenuated by Smokeless Tobacco: NEEDED (North Sea Race Endurance Exercise Study) 2014

Background Use of snus, a smokeless tobacco product, is increasing in Scandinavia. Strenuous physical activity is associated with an acute increase in high‐sensitivity cardiac troponin (swhs‐cTn) concentrations. Current smoking is associated with lower hs‐cTn, but whether this also holds true for smokeless tobacco and whether tobacco affects the hs‐cTn response to exercise remain unknown. Methods and Results We measured hs‐cTnI and hs‐cTnT concentrations in 914 recreational athletes before and 3 and 24 hours after a 91‐km bicycle race. Self‐reported snus tobacco habits were reported as noncurrent (n=796) and current (n=118). The association between snus use and change in log‐transformed hs‐cTnI and hs‐cTnT concentrations (ie, the differences between concentrations at baseline and 3 hours and 24 hours ) were assessed by multivariable linear regression analysis. Concentrations of hs‐cTn at baseline were lower in current than in noncurrent snus users (hs‐cTnI median, 1.7 ng/L; Q1 to Q3: 1.6–2.3 versus 2.0 ng/L; Q1 to Q3: 1.6–3.2 [P=0.020]; and hs‐cTnT: median, 2.9 ng/L, Q1 to Q3: 2.9–3.5 versus 2.9 ng/L, Q1 to Q3: 2.9–4.3 [P=0.021]). In fully adjusted multivariable models, use of snus was associated with lower change in hs‐cTn concentrations from baseline to 3 hours (hs‐cTnI: −29% [P=0.002], hs‐cTnT: −18% [P=0.010]) and 24 hours (hscTnI: −30% [P=0.010], hs‐cTnT −19%, [P=0.013]). Conclusions Resting hs‐cTn concentrations are lower and the exercise‐induced cardiac troponin response is attenuated in current users of smokeless tobacco compared with nonusers. Further insight into the pathophysiological processes underlying the attenuated cardiac troponin response to exercise in tobacco users is needed.publishedVersio

The activity of pregnancy-associated plasma protein A (PAPP-A) as expressed by immunohistochemistry in atherothrombotic plaques obtained by aspiration thrombectomy in patients presenting with a ST-elevation myocardial infarction: a brief communication

<p>Abstract</p> <p>Background</p> <p>The expression of pregnancy-associated plasma protein A (PAPP-A) was identified by immunohistochemistry (IHC) in culprit atherothrombotic plaque specimens harvested from patients admitted with ST-segment elevation myocardial infarction (STEMI).</p> <p>Methods</p> <p>The atherothrombotic samples were collected from a consecutive cohort consisting of 20 individuals admitted with STEMI to Stavanger University Hospital, Norway, from 2005-2006, presenting angiographically with an acute thrombotic occlusion of a coronary artery characterized by TIMI flow 0. The atherothrombotic plaques were obtained by aspiration thrombectomy during percutaneous coronary intervention within 12 hours from the onset of symptoms and prepared for IHC analysis.</p> <p>Results</p> <p>In the IHC analysis staining for PAPP-A occurred in the extracellular matrix of the plaques and no evidence of staining for PAPP-A was found in the thrombi.</p> <p>Conclusion</p> <p>Our results indicate that in vivo PAPP-A is strongly expressed in atherothrombotic plaques harvested from patients admitted with STEMI, as documented by IHC.</p> <p>Trial registration</p> <p><email>[email protected]</email></p

Occult obstructive coronary artery disease is associated with prolonged cardiac troponin elevation following strenuous exercise

Background Sudden cardiac death among middle-aged recreational athletes is predominantly due to myocardial ischaemia. This study examined whether measuring cardiac troponin I and T (cTnI and cTnT) after strenuous exercise could identify occult obstructive coronary artery disease. Design Prospective observational study. Methods Subjects were recruited from 1002 asymptomatic recreational cyclists completing a 91-km mountain bike race (North Sea Race Endurance Exercise Study). No subject had known cardiovascular disease or took cardiovascular medication. Blood samples were collected within 24 h before and 3 h and 24 h after the race. Coronary computed tomography angiography was performed in 80 participants with the highest post-exercise cTnI and in 40 reference subjects with moderately elevated cTnI values. Results Study subjects (N = 120) were 45 (36–52) years old and 74% were male. There were similar demographics in the High-cTnI group and the Reference group. The cTn concentrations were highest at 3 h post-race: cTnI, 224 (125–304) ng/L; cTnT, 89 (55–124) ng/L. Nine subjects had obstructive coronary artery disease on coronary computed tomography angiography, eight of whom were High-cTnI responders. Two subjects had myocardial bridging, both High-cTnI responders. Troponin concentrations at 24 h post-race were higher in subjects with obstructive coronary artery disease than in the rest of the cohort (n = 109): cTnI, 151 (72–233) ng/L vs. 24 (19–82) ng/L, p = 0.005; cTnT, 39 (25–55) ng/L vs. 20 (14–31) ng/L, p = 0.002. The areas under the receiver operating characteristic curves for predicting obstructive coronary artery disease were 0.79, p = 0.005 (cTnI) and 0.82, p = 0.002 (cTnT). Conclusion In subjects with occult obstructive coronary artery disease there was a prolonged elevation of cTn following strenuous exercise.acceptedVersio

Duration of elevated heart rate Is an important predictor of exercise-induced troponin elevation

Background The precise mechanisms causing cardiac troponin (cTn) increase after exercise remain to be determined. The aim of this study was to investigate the impact of heart rate (HR) on exercise‐induced cTn increase by using sports watch data from a large bicycle competition. Methods and Results Participants were recruited from NEEDED (North Sea Race Endurance Exercise Study). All completed a 91‐km recreational mountain bike race (North Sea Race). Clinical status, ECG, blood pressure, and blood samples were obtained 24 hours before and 3 and 24 hours after the race. Participants (n=177) were, on average, 44 years old; 31 (18%) were women. Both cTnI and cTnT increased in all individuals, reaching the highest level (of the 3 time points assessed) at 3 hours after the race (P150 beats per minute was a significant predictor of both cTnI and cTnT, at both 3 and 24 hours after exercise. Neither mean HR nor mean HR in percentage of maximum HR was a significant predictor of the cTn response at 3 and 24 hours after exercise. Conclusions The duration of elevated HR is an important predictor of physiological exercise‐induced cTn elevation.publishedVersio

Endurance exercise training volume is not associated with progression of coronary artery calcification

Background Recent cross‐sectional studies have suggested a dose‐dependent relationship between lifelong exposure to physical activity and the burden of calcified coronary artery disease (CAD). No longitudinal studies have addressed this concern. Hypothesis Exercise volume is associated with progression of coronary artery calcium (CAC), defined as ≥10 units increase in CAC score. Methods Sixty‐one recreational athletes who were assessed by coronary computed tomography angiography (CCTA) as part of the NEEDED 2013/14 study were re‐assessed 4‐5 years later, in 2018. Results Subjects were 45.9 ± 9.6 years old at inclusion, and 46 (74%) were male. Between 2013 and 2018, the participants reported median 5 (range: 0‐20, 25th‐75th percentile: 4‐6) hours of high‐intensity exercise per week. None of the included subjects smoked during follow‐up. At inclusion, 21 (33%) participants had coronary artery calcifications. On follow‐up CCTA in 2018, 15 (25%) subjects had progressive coronary calcification (≥10 Agatston units increase in CAC). These subjects were older (53 ± 9 vs 44 ± 9 years old, P = .002) and had higher levels of low‐density lipoprotein at baseline (3.5 (2.9‐4.3) vs 2.9 (2.3‐3.5) mmol/L, P = .031) as compared to subjects with stable condition. No relationship was found between hours of endurance training per week and progression of coronary artery calcification. In multiple regression analysis, age and baseline CAC were the only significant predictors of progressive CAC. Conclusion No relationship between exercise training volume and the progression of coronary artery calcification was found in this longitudinal study of middle‐aged recreational athletes.publishedVersio

Echocardiographic assessment of myocardial efficiency predicts exercise performance

Cardiac function is a major determinant of cardiopulmonary fitness. This study aimed to determine if novel echocardiographic myocardial function and efficiency parameters at rest can predict exercise performance during different types of prolonged high-intensity endurance exercise. Echocardiography was performed before exercise in 40 healthy (75% males) 50.3 ± 9.1-year-old recreational athletes. Echocardiographic parameters at rest were compared with exercise performance assessed by power output during two different exercises: A lactate threshold and cardiopulmonary exercise test (La-CPET) and a 91-km mountain bike sport cycling race. The La-CPET had a median duration of 43 (40, 45) minutes and a mean power output of 2.9 ± 0.5 W/kg. The race had a median duration of 236 (214, 268) minutes and a mean power output of 2.1 ± 0.5 W/kg. There was moderate left ventricular (LV) dilatation in individuals with the highest performance. The myocardial efficiency parameter, global wasted work (GWW), was positively correlated with race duration (rho = 0.42, p = 0.008) and negatively correlated with mean power output during both the La-CPET (rho = −0.43, p = 0.007) and the race (rho = −0.44, p = 0.005). In multivariable models, including LV volumes, left GWW remained an independent predictor of race duration (beta = 0.40, p = 0.007) and of mean power output during the La-CPET (beta = −0.40, p = 0.006) and the race (beta = −0.43, p = 0.003). The novel echocardiographic myocardial efficiency parameter, GWW, measured at rest, is an independent predictor of prolonged high-intensity endurance exercise performance in healthy middle-aged athletes. These findings suggest that resting myocardial efficiency parameters may aid the identification of exercise-induced LV dilatation.publishedVersio

Percutaneous coronary intervention in Europe 1992-2003

peer reviewedAims: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. We report the data of the year 2003 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed. Methods and results: Questionnaires were distributed yearly to delegates of all national societies of cardiology represented in the European Society of Cardiology to collect the case numbers of all local institutions and operators. The overall numbers of coronary angiographies increased from 1992 to 2003 from 684,000 to 1,993,000 (from 1,250 to 3,500 per million inhabitants). The respective numbers for percutaneous coronary interventions (PCI-coronary angioplasty) and coronary stenting procedures increased from 184,000 to 733,000 (from 335 to 1,300) and from 3,000 to 610,000 (from 5 to 1,100), respectively. Germany has been the most active country for the past years with 653,000 angiographies (7,800), 222,000 angioplasties (2,500), and 180,000 stenting procedures (2,200) in 2003. The indication has shifted towards acute coronary syndromes, as demonstrated by raising rates of interventions for acute myocardial infarction over the last decade. The procedures are more readily performed and safer, as shown by increasing rate of “ad hoc” PCI and decreasing need for emergency coronary artery bypass surgery (CABG). In 2003, use of drug-eluting stents had further increased. However, an enormous variability is reported with the highest rate in Portugal (55%). Conclusion: Interventional cardiology in Europe is still expanding, mainly but not exclusively due to rapid growth in the eastern European countries. A number of new coronary revascularization procedures introduced over the years have all but disappeared. Only stenting has experienced an exponential growth. The same can be forecast for drug-eluting stenting

The copeptin response after physical activity is not associated with cardiac biomarkers or asymptomatic coronary artery disease: The North Sea Race Endurance Exercise Study (NEEDED) 2013

Background:Copeptin concentrations increase both during acute coronary syndrome and following physicalexercise. The relationship between copeptin increase following physical exercise and coronary artery disease(CAD) is uncertain. The aim of this study was to 1) describe the copeptin response following strenuous physicalexercise, and 2) investigate the determinants of exercise induced copeptin concentrations, particularly in rela-tion to cardiac biomarkers and CAD.Methods:Serum samples were collected from 97 recreational cyclists 24 h before, and immediately, 3 and 24 hafter a 91-km bike race. Three subjects were subsequently diagnosed with significant asymptomatic CAD. Deltacopeptin concentrations were correlated to patient characteristics and to biomarker concentrations.Results:Participants were 42.8 ± 9.6 years, and 76.3% were male. Copeptin concentrations increased tomaximal levels immediately after the race and were normalized in > 90% after 3 h. A total of 53% and 39%exceeded the 95th and 99th percentile of the assay (10 and 19 pmol/L) respectively. In multivariate models, racetime, serum sodium, creatinine and cortisol were significant predictors of copeptin levels. There was no cor-relation between changes in copeptin and changes in cardiac biomarkers (hs-cTnI, hs-cTnT and BNP). Copeptinconcentrations were normal in the subjects with asymptomatic CAD.Conclusions:The moderate, short-term, exercise induced copeptin increase observed in the present study was notrelated to hs-cTn or BNP levels. Copeptin was normal in three asymptomatic recreational athletes with significant CAD

Regular consumption of cod liver oil is associated with reduced basal and exercise-induced C-reactive protein levels; a prospective observational trial

Background Dietary supplement use among recreational athletes is common, with the intention of reducing inflammation and improving recovery. We aimed to describe the relationship between omega-3 fatty acid supplement use and inflammation induced by strenuous exercise. Methods C-reactive protein (CRP) concentrations were measured in 1002 healthy recreational athletes before and 24 h after a 91-km bicycle race. The use of omega-3 fatty acid supplements was reported in 856 out of 1002 recreational athletes, and the association between supplement use and the exercise-induced CRP response was assessed. Results Two hundred seventy-four subjects reported regular use of omega-3 fatty acid supplements. One hundred seventy-three of these used cod liver oil (CLO). Regular users of omega-3 fatty acid supplements had significantly lower basal and exercise-induced CRP levels as compared to non-users (n = 348, p < 0.001). Compared to non-users, regular users had a 27% (95% confidence interval (CI): 14–40) reduction in Ln CRP response (unadjusted model, p < 0.001) and 16% (95% CI: 5–28, p = 0.006) reduction after adjusting for age, sex, race duration, body mass index, delta creatine kinase, MET hours per week, resting heart rate and higher education. CLO was the primary driver of this response with a 34% (95% CI: 19–49) reduction (unadjusted model, p < 0.001) compared to non-users. Corresponding numbers in the adjusted model were 24% (95% CI: 11–38, p < 0.001). Conclusion Basal CRP levels were reduced, and the exercise-induced CRP response was attenuated in healthy recreational cyclists who used omega-3 fatty acid supplements regularly. This effect was only present in regular users of CLO.publishedVersio