Biomarker changes after strenuous exercise can mimic pulmonary embolism and cardiac injury--a metaanalysis of 45
Farbod Sedaghat-Hamedani1, Elham Kayvanpour1, Lutz Frankenstein2
1Department of Medicine III, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), Germany;
Insights
Strenuous exercise significantly alters cardiac biomarkers like troponins and BNP, potentially mimicking serious heart conditions. Clinicians must consider recent physical activity when evaluating suspected cardiac emergencies.
Area of Science:
- Cardiology
- Sports Medicine
- Biomarker Research
Background:
- Established cardiac biomarkers (troponins, BNP, d-dimers) aid in diagnosing myocardial infarction, heart failure, and thromboembolism.
- Strenuous exercise can acutely elevate these biomarkers and alter cardiac function, potentially mimicking cardiovascular emergencies.
- This can complicate clinical assessments and diagnostic interpretations in athletes and active individuals.
Purpose of the Study:
- To systematically review and meta-analyze changes in cardiovascular biomarkers and cardiac imaging after endurance exercise.
- To assess the impact of strenuous physical activity on commonly used diagnostic cardiac markers.
- To provide evidence for considering exercise-induced changes in clinical decision-making.
Main Methods:
- Systematic review and meta-analysis of observational studies.
- Search conducted for English-language studies from 1997 to 2014.
- Included studies assessed cardiac biomarkers or cardiac function/morphology post-endurance exercise.
Main Results:
- Elevated cardiac troponin T (cTnT) above the clinical cutoff (>0.01 ng/mL) observed in 51% of participants.
- Significant pooled increases in hs-cTnT, cTnI, BNP, NT-proBNP, and d-dimer levels post-exercise.
- Right ventricular dimensions increased, while right ventricular ejection fraction and early-to-late transmitral flow ratio decreased; left ventricular ejection fraction remained unchanged.
Conclusions:
- Commonly used cardiovascular biomarkers are susceptible to alterations following strenuous exercise.
- Exercise-induced changes can mimic conditions like acute coronary syndrome, heart failure, and pulmonary embolism.
- Clinical evaluation for cardiac emergencies requires consideration of recent strenuous physical activity.
Background:
Biomarkers are well established for diagnosis of myocardial infarction [cardiac troponins, high-sensitivity cardiac troponins (hs-cTn)], exclusion of acute and chronic heart failure [B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP)] and venous thromboembolism (d-dimers). Several studies have demonstrated acute increases in cardiac biomarkers and altered cardiac function after strenuous sports that can pretend a cardiovascular emergency and interfere with state-of-the-art clinical assessment.
Methods:
We performed a systematic review and metaanalysis of biomarker and cardiovascular imaging changes after endurance exercise. We searched for observational studies published in the English language from 1997 to 2014 that assessed these biomarkers or cardiac function and morphology directly after endurance exercise. Of 1787 identified abstracts, 45 studies were included.
Results:
Across all studies cardiac troponin T (cTnT) exceeded the cutoff value (0.01 ng/mL) in 51% (95% CI, 37%-64%) of participants. The measured pooled changes from baseline for high-sensitivity cTnT (hs-cTnT) were +26 ng/L (95% CI, 5.2-46.0), for cTnI +40 ng/L (95% CI, 21.4; 58.0), for BNP +10 ng/L (95% CI, 4.3; 16.6), for NT-proBNP +67 ng/L (95% CI, 49.9; 84.7), and for d-dimer +262 ng/mL (95% CI, 165.9; 358.7). Right ventricular end diastolic diameter increased and right ventricular ejection fraction as well as the ratio of the early to late transmitral flow velocities decreased after exercise, while no significant changes were observed in left ventricular ejection fraction.
Conclusions:
Current cardiovascular biomarkers (cTnT, hs-cTnT, BNP, NT-proBNP, and d-dimer) that are used in clinical diagnosis of pulmonary embolism, acute coronary syndrome, and heart failure are prone to alterations due to strenuous exercise. Hence, it is necessary to take previous physical exercise into account when a cardiac emergency is suspected.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Pulmonary Embolism I: Introduction
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care