Biomarcadores de fibrosis y función ventricular derecha en maratonistas con distinto grado de entrenamiento: estudio en la maratón de Santiago / Fibrosis and right ventricular function biomarkers in marathon runners: a study at the Santiago, Chile marathon

Resumen: Introducción: Atletas altamente entrenados muestran cambios cardíacos estructurales como adaptación a la sobrecarga, producto del ejercicio repetitivo y extenuante. Se han evidenciado elevación de biomarcadores de remodelado y fibrosis miocárdica posterior al ejercicio intenso en atletas. Sin embargo, el comportamiento de estos biomarcadores según el nivel de entrenamiento previo no se ha evaluado. Objetivo: Investigar biomarcadores de fibrosis y función ventricular derecha en maratonistas con distinto nivel de entrenamiento previo. Métodos: Se incluyeron 36 maratonistas hombres, sanos, que completaron 42 km en la maratón de Santiago. Se dividieron según entrenamiento previo en dos grupos, Grupo 1 (G1): ≥100 km/semana y Grupo 2 (G2): <100 km/semana. Se realizó ecocardiografía transtorácica y se evaluaron niveles plasmáticos de galectina-3 y del propéptido amino terminal del procolágeno tipo III (PIIINP) en la semana previa a la carrera e inmediatamente posterior a ésta. Resultados: Posterior a la maratón, la función sistólica del ventrículo derecho disminuyó en el grupo G2 junto con un aumento significativo de los niveles plasmáticos de PIIIPNP (61±16 a 94±24 ng/mL, p=0,01). Estos cambios no se observaron en el grupo G1 (65 ± 11 a 90±29 ng/mL, p=0,10). Los niveles plasmáticos de galectina-3 aumentaron significativamente en ambos grupos posterior al ejercicio (6,8±2,2 a 19,7±4,9 ng/mL, p 0,012 y 6,0±1,1 a 19,4 ± 5,9 ng/mL, p 0,01) en los grupos G1 y G2, respectivamente). Conclusiones: Atletas con menor grado de entrenamiento, presentan posterior a una maratón un significativo aumento de productos de degradación del colágeno (PIIIPNP) asociado a disminución de la función del ventrículo derecho. Los niveles de galectina-3 plasmática aumentan significativamente en ambos grupos post-esfuerzo independiente del entrenamiento previo.

Abstracts: Introduction: Highly trained athletes show structural cardiac changes as adaptation to overload. Rise in remodeling biomarkers and myocardial fibrosis after intense exercise in athletes has been evidenced; however, the behavior of these biomarkers according to pre-competition training level has not been evaluated. Objective: To evaluate fibrosis biomarkers levels and right ventricle function in marathon runners according to their previous training level, in the period prior to a marathon race and immediately after it. Methods: Thirty-six healthy male marathon runners were included. Subjects were grouped according to their previous training level: Group 1 (G1): ≥100 km/week and Group 2 (G2): <100 km/week. Transthoracic echocardiography along with plasmatic levels of galectin-3 and amino terminal propeptide of type III procollagen (PIIINP) were measured one week previous and immediately after the marathon. Results: Post-effort right ventricle systolic function decreased in G2, together with a significant elevation of PIIIPNP (61±16 to 94±24 ng/mL, p=0.01). These changes were not observed in G1 (from 65±11 to 90±29 ng/mL, p=0.10). Plasma galectin-3 increased significantly in both groups immediately post-exercise (6.8±2.2 to 19.7±4.9 ng/mL, p=0.012, and 6.0±1.1 to 19.4±5.9 ng/mL, p=0.01, in G1 and G2. respectively). Conclusion: Less trained athletes evidenced higher post marathon levels of PIIIPNP which is associated with a decreased global right ventricle function. Plasma galectin-3 levels increased significantly after intense exertion regardless of the intensity of previous training.

Red blood cell distribution width is associated with myocardial injury in non-ST-elevation acute coronary syndrome

OBJECTIVES: The red blood cell distribution width has been associated with an increased risk of cardiovascular events. In the present study, we assessed the relationship between red cell distribution width values and cardiac troponin I levels in patients admitted with non-ST-elevation acute coronary syndrome. METHODS: We analyzed blood parameters in 251 adult patients who were consecutively admitted to the intensive coronary care unit with non-ST-elevation acute coronary syndrome over a 1-year period. For all patients, a baseline blood sample was collected for routine hematological testing. Cardiac troponin I was measured at baseline and after 6 h. The patients were diagnosed with non-ST-elevation myocardial infarction or unstable angina based on the elevation of cardiac troponin I levels. RESULTS: The red cell distribution width was higher in the group with non-ST-elevation myocardial infarction compared with the patient group with unstable angina (14.6±1.0 vs 13.06±1.7, respectively; p = 0.006). Coronary thrombus was detected more frequently in the group of patients with non-ST-elevation myocardial infarction than in the patients with unstable angina (72% vs 51%, respectively; p = 0.007). Using receiver operating characteristic curve analysis for the prediction of non-ST-elevation myocardial infarction based on the red cell distribution width, the area under the curve was 0.649 (95% confidence interval: 0.546-0.753; p = 0.006), suggesting a modest model for the prediction of non-ST-elevation myocardial infarction using the red cell distribution width. At a cut-off value of 14%, the sensitivity and specificity of the red cell distribution width were 73% and 59%, respectively. Additionally, the red cell distribution width was positively correlated with cardiac troponin I (r = 0.19; p = 0.006). CONCLUSION: A greater baseline red cell distribution width value was associated with ...

Correlaciòn electrica del lam sest y las lesiones coronarias / Lam correlation of electrical and coronary lesions sest

El sìndrome coronario agudo sin elevaciòn del segmento ST constituye una causa frecuente de consulta en los servicios de urgencia y de hospitalizaciòn en las unidades de cuidados intensivos o de reanimaciòn..

Cardioversão elétrica e lesão miocárdica: avaliação pelos novos marcadores de injúria cardíaca / Electrical cardioversion and myocardial injury: evaluation by new cardiac injury markers

OBJETIVO: Avaliar, através da evolução dos novos marcadores bioquímicos de injúria cardíaca, se a cardioversão elétrica (CVE) causa lesão miocárdica. MÉTODOS: Foram avaliados 76 pacientes (P) submetidos a CVE eletiva de fibrilação atrial ou flutter atrial. Medidas de creatinafosfoquinase (CPK), CKMB-atividade e dosagem de CKMB-massa (M), mioglobina e troponina I cardíaca (cTnI) foram determinadas antes e após 6 e 24 horas da CVE. RESULTADOS: A CVE resultou um sucesso em 58 P (76,3 por cento). A carga cumulativa (CC) foi de até 350 joules (J) em 36 P, de 500 a 650 J em 20 P e de 900 a 960 J em 20 P, com energia média aplicada de 493 J (± 309). A cTnI permaneceu dentro da normalidade nos 76 P. Com o aumento da CC, ocorreu elevação de CPK (> valor de p = 0,007), CKMB-atividade (> valor de p = 0,002), CKMB-M (> valor de p = 0,03) e mioglobina (> valor de p = 0,015). Correlação positiva foi observada entre a CC e picos de CPK (r = 0,660; p < 0,001), CKMB-atividade (r = 0,429; p < 0,0001), CKMB-M (r = 0,265; p = 0,02) e mioglobina (r = 0,684; p < 0,0001). Correlação também positiva ocorreu entre o número de choques e picos de CPK (r = 0,770; p < 0,001), CKMB-atividade (r = 0,642; p < 0,0001), CKMB-M (r = 0,430; p < 0,0001) e mioglobina (r = 0,745; p < 0,0001). CONCLUSÃO: A CVE não causa lesão miocárdica detectável pela dosagem da cTnI. Elevações de CPK, CKMB-atividade, CKMB-M e mioglobina são decorrentes de lesão do músculo esquelético, estando correlacionadas positivamente com a CC aplicada ou com o número de choques.