Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Bethanienstrasse 21, 47441, Moers, Germany,
Basic Res Cardiol. 2014 Jan;109(1):391. doi: 10.1007/s00395-013-0391-8. Epub 2013 Nov 19.
We determined the prognostic value of transient increases in high-sensitive serum troponin I (hsTnI) during a marathon and its association with traditional cardiovascular risk factors and imaging-based risk markers for incident coronary events and all-cause mortality in recreational marathon runners. Baseline data of 108 marathon runners, 864 age-matched controls and 216 age- and risk factor-matched controls from the general population were recorded and their coronary event rates and all-cause mortality after 6 ± 1 years determined. hsTnI was measured in 74 marathon finishers before and after the race. Other potential predictors for coronary events, i.e., Framingham Risk Score (FRS), coronary artery calcium (CAC) and presence of myocardial fibrosis as measured by magnetic resonance imaging-based late gadolinium enhancement (LGE), were also assessed. An increase beyond the 99 % hsTnI-threshold, i.e., 0.04 μg/L, was observed in 36.5 % of runners. FRS, CAC, or prevalent LGE did not predict hsTnI values above or increases in hsTnI beyond the median after the race, nor did they predict future events. However, runners with versus without LGE had higher hsTnI values after the race (median (Q1/Q3), 0.08 μg/L (0.04/0.09) versus 0.03 μg/L (0.02/0.06), p = 0.039), and higher increases in hsTnI values during the race (median (Q1/Q3), 0.05 μg/L (0.03/0.08) versus 0.02 μg/L (0.01/0.05), p = 0.0496). Runners had a similar cumulative event rate as age-matched or age- and risk factor-matched controls, i.e., 6.5 versus 5.0 % or 4.6 %, respectively. Event rates in runners with CAC scores <100, 100-399, and ≥400 were 1.5, 12.0, and 21.4 % (p = 0.002 for trend) and not different from either control group. Runners with coronary events had a higher prevalence of LGE than runners without events (57 versus 8 %, p = 0.003). All-cause mortality was similar in marathon runners (3/108, 2.8 %) and controls (26/864, 3.0 % or 5/216, 2.4 %, respectively). Recreational marathon runners with prevalent myocardial fibrosis develop higher hsTnI values during the race than those without. Increasing coronary artery calcium scores and prevalent myocardial fibrosis, but not increases in hsTnI are associated with higher coronary event rates. All-cause mortality in marathon runners is similar to that in risk factor-matched controls.
我们确定了在马拉松比赛中，高敏血清肌钙蛋白 I（hsTnI）一过性升高的预后价值，并研究了其与传统心血管危险因素和基于影像学的冠心病风险标志物之间的关系，旨在评估其与冠心病事件和全因死亡率的相关性。我们记录了 108 名马拉松运动员、864 名年龄匹配的对照组和 216 名年龄和危险因素匹配的普通人群对照组的基线数据，并在 6±1 年后确定了他们的冠心病事件发生率和全因死亡率。我们在 74 名马拉松完赛者比赛前后均检测了 hsTnI。还评估了其他潜在的冠心病预测因子，如Framingham 风险评分（FRS）、冠状动脉钙（CAC）和磁共振成像（MRI）晚期钆增强（LGE）检测到的心肌纤维化的存在。36.5%的跑步者出现了超过 99%hsTnI 阈值（即 0.04μg/L）的升高。FRS、CAC 或 LGE 的存在并不能预测比赛后 hsTnI 值超过中位数或超过中位数的 hsTnI 升高，也不能预测未来的事件。然而，与没有 LGE 的跑步者相比，有 LGE 的跑步者比赛后的 hsTnI 值更高（中位数（Q1/Q3），0.08μg/L（0.04/0.09）比 0.03μg/L（0.02/0.06），p=0.039），并且在比赛期间的 hsTnI 值升高幅度更大（中位数（Q1/Q3），0.05μg/L（0.03/0.08）比 0.02μg/L（0.01/0.05），p=0.0496）。跑步者的累积事件发生率与年龄匹配或年龄和危险因素匹配的对照组相似，即 6.5%与 5.0%或 4.6%。CAC 评分<100、100-399 和≥400 的跑步者的事件发生率分别为 1.5%、12.0%和 21.4%（趋势 p=0.002），与对照组无差异。与无事件的跑步者相比，有冠心病事件的跑步者 LGE 的发生率更高（57%比 8%，p=0.003）。马拉松运动员的全因死亡率（3/108，2.8%）与对照组（26/864，3.0%或 5/216，2.4%）相似。有心肌纤维化的业余马拉松运动员在比赛中 hsTnI 值升高幅度高于无心肌纤维化者。增加冠状动脉钙评分和心肌纤维化的存在，但不是 hsTnI 的增加，与更高的冠心病事件发生率相关。马拉松运动员的全因死亡率与危险因素匹配的对照组相似。
