Exploring the predictors and prognostic significance of exercise-induced cardiac troponin release in master athletes following a 28 km mountain race. The Vamvakou research project.

BACKGROUND/OBJECTIVE: Aetiology and significance of exercise-induced troponin release remains a contentious issue. We investigated the effect of a 28 km mountain run on cardiac troponin I (cTnI), in relation to training, performance, nutritional, biochemical and echocardiography variables, in a group of 25 recreational male master athletes. MATERIAL AND METHODS: A comprehensive list of variables related with nutrition, training, performance and echocardiography, was collected pre- and post-race. Twenty-four months later, outcomes regarding cardiovascular events were obtained. RESULTS: Serum cTnI values were increased after the race, with mean values rising from 7.2 ± 2.2 (before) to 80.0 ± 33.2 ng/L (post race), (p < 0.001) and 23/25(92%) exceeding Upper Reference limit (50 ng/L). Echocardiography did not reveal significant alterations, or correlations with cTnI values. The percentage difference in hs-cTnI concentrations pre- and post-race correlated positively with age, race-induced changes of selected muscle damage indices, resistance training volume and negatively with endurance capacity and training volume (r: -0.727 to 0.725, p < 0.05). All athletes reported no cardiovascular event during the 24-month period post-race. CONCLUSION: cTnI elevation induced by a 28 km mountain running race was not correlated with echocardiographic, nutritional parameters and was less pronounced in athletes with larger endurance training history, in contrast with resistance training and age.

Enhanced external counterpulsation for treatment of refractory angina pectoris.

OBJECTIVE: Enhanced external counterpulsation (EECP) is a noninvasive, well-tolerated treatment, effective for managing patients with refractory angina pectoris. The aim of this study was to evaluate the efficacy of EECP to relieve symptoms, to decrease myocardial ischaemia and to improve cardiac performance in patients with intractable angina, refractory to surgical and medical treatment. METHODS: Twenty-five patients (24 men and one woman, mean age 65 years) with persistent ischaemia notwithstanding optimal medical therapy or after interventional or surgical procedure, received EECP sessions for 35 h. Each patient underwent dobutamine stress echocardiography before and after treatment. We evaluated modifications in either cardiac systolic or diastolic function, and in wall motion score index. RESULTS: Eighty-four percent of patients showed an increase in at least one functional angina class. We did not observe any significant changes in fractional shortening and diastolic function. Thirty-six percent of patients had a reduction in the area of inducible ischaemia at dobutamine stress echocardiography after treatment. Unfortunately, because of the small sample size, we did not find any statistically significant difference. There was a trend showing that patients who benefited the most were those with the worst systolic function and with severely compromised segmental kinesis (P = NS). CONCLUSIONS: EECP is effective in relieving symptoms in patients with refractory angina and may reduce inducible ischaemia at dobutamine stress echocardiography, especially in patients with reduced systolic function and compromised segmental kinesis.

Effect of enhanced external counterpulsation on dobutamine-induced left ventricular wall motion abnormalities in severe chronic angina pectoris.

We studied the effect of enhanced external counterpulsation (EECP) in 23 consecutive patients with stable angina pectoris who had a positive dobutamine stress echocardiogram. After EECP, stress-induced wall motion score (WMS) improved by > or =2 grades in 43% of the patients (n = 10); the average improvement was 5.3 +/- 3.8 compared with -0.6 +/- 3.0 in the remaining 13 patients (p = 0.007). The diastolic/systolic augmentation ratio increased by 217% in response to the full course of EECP (p = 0.0002) among patients with improved WMS, and by 71% (p = 0.004) among the other patients; the increase was greater among patients with improved WMS than among patients with no improvement (p = 0.01). After EECP, Canadian Cardiovascular Society angina class improved from 3.1 +/- 0.6 to 2.2 +/- 0.7 (p <0.0001) in the entire group and exercise capacity increased by 73 seconds (p = 0.0002) in patients who were able to exercise (n = 18).