Elsevier

American Heart Journal

Volume 150, Issue 6, December 2005, Pages 1128-1134
American Heart Journal

Clinical Investigation
Prevention and Rehabilitation
Independent elevations of N-terminal pro–brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise

https://doi.org/10.1016/j.ahj.2005.01.051Get rights and content

Background

Although elevated resting brain natriuretic peptide (BNP) concentrations reflect heart disease, the meaning of exercise-induced increases is poorly understood and has been examined in small groups only. Therefore, the present study aimed to examine the increase in N-terminal pro–brain natriuretic peptide (NT-proBNP) and relations to cardiac troponin I and T (cTnI, cTnT) elevations after prolonged strenuous exercise in a large cohort of athletes.

Methods

We examined exercise-induced changes in NT-proBNP, cTnI, and cTnT in 105 obviously healthy endurance athletes (40 ± 8 years) before and after prolonged strenuous exercise. Blood samples were taken before, 15 minutes, and 3 hours after a marathon (n = 46), a 100-km run (n = 14), and a mountain bike marathon (n = 45).

Results

Eighty-one of 105 athletes exceeded the upper reference limit of NT-proBNP (males/females 88:153 ng/L) after exercise. NT-proBNP increased in all 3 events (P < .001) with the highest increase in the 100-km runners (median increase 200 ng/L; 25th/75th percentile 115/770 ng/L), which differed from the increase in the marathon (97 ng/L; 36/254 ng/L) or the mountain bike marathon (78 ng/L; 37/196 ng/L) (P < .01). Cardiac troponin I exceeded 0.04 μg/L in 74%; cTnT exceeded 0.01 μg/L in 47% of athletes after exercise. NT-proBNP was not related to exercise-induced increases in cTnI or cTnT, but correlated with exercise time (r = 0.55, P < .001).

Conclusions

Increases in NT-proBNP can be found in a major part of obviously healthy athletes after prolonged strenuous exercise. The release of BNP during and after exercise may not result from myocardial damage but may have cytoprotective and growth-regulating effects. The different nature of exercise-induced increases in BNP and cardiac troponins has to be elucidated in the future.

Section snippets

Study population

In total, 105 endurance athletes were examined at 3 endurance exercise events: a marathon (Mainz Marathon 2002, Germany), a 100-km ultramarathon (German Championship 2002), and a MTB marathon (St Wendel MTB-Marathon 2002, distance 110 km, altitude difference 2800 m). All randomly selected participants gave their written informed consent and filled in a questionnaire to register health status and cardiovascular risk factors (hypercholesterinemia, hypertension, familial predisposition of coronary

Results

Individual courses of NT-proBNP, cTnI, and cTnT of the participants are presented in Figure 1; median concentrations and exercise-induced changes of NT-proBNP, cTnI, and cTnT are presented in Figure 2.

Discussion

The results of the present study, which is the largest on exercise-induced alterations on NT-proBNP (or BNP) and cardiac troponins so far, indicate that prolonged strenuous exercise induces an increase in NT-proBNP, which is not related to the exercise-induced increases in cTnI or cTnT.

Although BNP or NT-proBNP have become hopeful markers in the diagnosis and treatment of patients with heart disease,1, 3, 6, 12, 13 the mechanisms leading to exercise-induced increases in BNP or NT-proBNP and

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    The study was supported by a grant of the National Institute for Sports Sciences (Bundesinstitut für Sportwissenschaft: VF 0407/01/32/2002-2003), Bonn, Germany.

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