运动诱导心肌肌钙蛋白升高与中年运动员隐匿性冠状动脉粥样硬化的关系

IF 22.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American College of Cardiology Pub Date : 2025-06-16 DOI:10.1016/j.jacc.2025.04.047

Sylvan L.J.E. Janssen MD , Wouter M. van Everdingen MD, PhD , Wouter B.J. Saalmink MSc , Sacha K. Lamers MSc , Wim H.M. Vroemen PhD , Ellen J.S. Denessen MSc , Kristian Berge MD, PhD , Otto Bekers PhD , Maria T.E. Hopman MD, PhD , Monique Brink MD, PhD , Jesse Habets MD, PhD , Vincent L. Aengevaeren MD, PhD , Alma M.A. Mingels PhD , Robin Nijveldt MD, PhD , Thijs M.H. Eijsvogels PhD

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引用次数: 0

摘要

背景：运动增加心肌肌钙蛋白（cTn）浓度，个体间存在显著异质性。目的：本研究比较运动后cTn浓度高与低的中年休闲运动员冠状动脉粥样硬化的患病率和程度。方法对1011名长距离步行者、骑自行车者和跑步者（中位年龄56岁[Q1-Q3: 49-62岁]，63%为男性）进行运动前后高敏感性心肌肌钙蛋白T （hs-cTnT）和hs-cTnI浓度的评估。随后，68例高cTn应答者(hs-cTnT: 35.4 ng/L [Q1-Q3: 20.2-54.0 ng/L]；hs-cTnT: 47.4 ng/L [Q1-Q3: 22.5-97.4 ng/L])和34名低反应者（hs-cTnT: 8.5 ng/L [Q1-Q3: 5.4-13.3 ng/L]）；hs-cTnI: 2.5 ng/L [Q1-Q3: 1.5-5.8 ng/L])，与年龄、性别和运动类型相匹配，进行心脏计算机断层扫描（CT）以确定冠状动脉粥样硬化的存在和特征（冠状动脉疾病报告和数据系统[CAD-RADS] 2.0评分和冠状动脉钙评分）。ct衍生的分数血流储备（CT-FFR）分析评估了狭窄的血流动力学相关性≥25%至90%。结果CAD-RADS患病率67.6% vs 50.0%；or校正：1.55 [95% CI: 0.81-2.93])和幅度(冠状动脉钙评分：9 AU [Q1-Q3: 0-111 AU] vs 2 AU [Q1-Q3: 0-145 AU]；P = 0.58)冠状动脉粥样硬化在高、低cTn应答者之间无差异。CT-FFR结果(FFR≤0.75:11.8% vs 5.9%；ORadjusted: 1.03 [Q1-Q3: 0.67-1.60])也显示高cTn应答者和低cTn应答者之间没有差异。然而，弱关联(P <；0.05;在hs-cTnT、hs-cTnI浓度和CAD-RADS分类之间存在R2: 4%-8%)。结论运动后cTn浓度高与低的休闲运动员冠状动脉粥样硬化的患病率和程度无显著差异。这表明，运动引起的cTn升高的大多数个体间差异不能归因于隐性冠状动脉粥样硬化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes

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Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes

Background

Exercise increases cardiac troponin (cTn) concentrations with significant heterogeneity across individuals.

Objectives

This study compared the prevalence and magnitude of coronary atherosclerosis in middle-aged recreational athletes with high vs low postexercise cTn concentrations.

Methods

Pre- and postexercise concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and hs-cTnI were assessed among 1,011 long-distance walkers, cyclists, and runners (median age 56 years [Q1-Q3: 49-62 years], 63% male). Subsequently, 68 high cTn responders (hs-cTnT: 35.4 ng/L [Q1-Q3: 20.2-54.0 ng/L]; hs-cTnI: 47.4 ng/L [Q1-Q3: 22.5-97.4 ng/L]) and 34 low responders (hs-cTnT: 8.5 ng/L [Q1-Q3: 5.4-13.3 ng/L]; hs-cTnI: 2.5 ng/L [Q1-Q3: 1.5-5.8 ng/L]), matched for age, sex, and sport type, underwent a cardiac computed tomography (CT) scan to determine the presence and characteristics of coronary atherosclerosis (Coronary Artery Disease-Reporting and Data System [CAD-RADS] 2.0 score and coronary artery calcium scores). CT-derived fractional flow reserve (CT-FFR) analyses assessed the hemodynamic relevance of stenoses ≥25% to 90%.

Results

The prevalence (CAD-RADS >0 in 67.6% vs 50.0%; OR_adjusted: 1.55 [95% CI: 0.81-2.93]) and magnitude (coronary artery calcium score: 9 AU [Q1-Q3: 0-111 AU] vs 2 AU [Q1-Q3: 0-145 AU]; P = 0.58) of coronary atherosclerosis did not differ between high and low cTn responders. CT-FFR outcomes (FFR ≤0.75: 11.8% vs 5.9%; OR_adjusted: 1.03 [Q1-Q3: 0.67-1.60]) also revealed no differences between high and low cTn responders. Nevertheless, weak associations (P < 0.05; R²: 4%-8%) were found between hs-cTnT, hs-cTnI concentrations, and CAD-RADS classifications.

Conclusions

The prevalence and magnitude of coronary atherosclerosis did not differ between recreational athletes with high vs low postexercise cTn concentrations. This suggests that most of the interindividual variation in exercise-induced cTn elevations is not attributable to occult coronary atherosclerosis.

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来源期刊

Journal of the American College of Cardiology 医学-心血管系统

CiteScore

42.70

自引率

3.30%

发文量

5097

审稿时长

2-4 weeks

期刊介绍： The Journal of the American College of Cardiology (JACC) publishes peer-reviewed articles highlighting all aspects of cardiovascular disease, including original clinical studies, experimental investigations with clear clinical relevance, state-of-the-art papers and viewpoints. Content Profile: -Original Investigations -JACC State-of-the-Art Reviews -JACC Review Topics of the Week -Guidelines & Clinical Documents -JACC Guideline Comparisons -JACC Scientific Expert Panels -Cardiovascular Medicine & Society -Editorial Comments (accompanying every Original Investigation) -Research Letters -Fellows-in-Training/Early Career Professional Pages -Editor’s Pages from the Editor-in-Chief or other invited thought leaders