Alterations in left ventricular function and cardiac biomarkers as a consequence of repetitive endurance cycling

Impact of long-lasting moderate-intensity stage cycling event on cardiac function in young female athletes: A case study

PURPOSE

Effects of intense and/or prolonged exercise have been studied extensively in male athletes. Nevertheless, data are scare on the effect of long duration events on cardiac function in female athletes. Our aim was to investigate the effect of a long-lasting moderate-intensity stage cycling event on cardiac function of young female athletes.

METHODS

Seven well-trained female cyclists were included. They completed a cycling event of 3529 km on 23 days. All underwent an echocardiography on 6 time-points (baseline and at the arrival of day (D) 3, 7, 12, 13 and 23). Cardiac function was assessed by conventional echocardiography, tissue Doppler imaging and speckle tracking techniques. Daily exercise load was determined by heart rate (HR), power output and rate of perceived exertion data (RPE, Borg scale).

RESULTS

All stages were mainly done at moderate intensity (average HR: 65% of maximal, average aerobic power output: 36% of maximal, average RPE: 4). Resting HR measured at the time of echocardiography did not vary during the event. Resting cardiac dimensions did not significantly change during the 23 days of cycling. No significant modification of cardiac function, whatever the studied cavity, were observed all along the event.

CONCLUSION

The results suggest that, in the context of our case study, the long-lasting moderate-intensity stage cycling event was not associated with cardiac function alteration. Nevertheless, we must be careful in interpreting them due to the limits of an underpowered study.

Short-term exercise affects cardiac function ex vivo partially via changes in calcium channel levels, without influencing hypoxia sensitivity

Exercise is known to improve cardiac recovery following coronary occlusion. However, whether short-term exercise can improve cardiac function and hypoxia tolerance ex vivo independent of reperfusion injury and the possible role of calcium channels in improved hypoxia tolerance remains unknown. Therefore, in the current study, heart function was measured ex vivo using the Langendorff method at different oxygen levels after a 4-week voluntary wheel-running regimen in trained and untrained male mice (C57Bl/6NCrl). The levels of cardiac Ca²⁺-channels: L-type Ca²⁺-channel (CACNA1C), ryanodine receptor (RyR-2), sarco(endo)plasmic reticulum Ca²⁺-ATPase (SERCA2), and sodium-calcium exchanger were measured using western blot. Trained mice displayed lower cardiac afterload pressure generation capacity (rate and amplitude), but unaltered hypoxia tolerance when compared to untrained mice with similar heart rates. The level of CACNA1C positively correlated with the pressure generation rate and amplitude. Furthermore, the CACNA1C-RYR-2 ratio also positively correlated with the pressure generation rate. While the 4-week training period was not enough to alter the intrinsic cardiac hypoxia tolerance, interestingly it decreased pressure generation capacity and slowed pressure decreasing capacity in the mouse hearts ex vivo. This reduction in pressure generation rate could be linked to the level of channel proteins in sarcolemmal Ca²⁺-cycling in trained mice. However, the Ca^2+-channel levels did not differ significantly between the groups, and thus, the level of calcium channels cannot fully explain all the functional alterations, despite the detected correlations. Therefore, additional studies are warranted to reveal further mechanisms that contribute to the reduced intrinsic capacity for pressure production in trained mouse hearts.

Effect of ingesting carbohydrate only or carbohydrate plus casein protein hydrolysate during a multiday cycling race on left ventricular function, plasma volume expansion and cardiac biomarkers

PURPOSE

Multiday racing causes mild left ventricular (LV) dysfunction from day 1 that persists on successive days. We evaluated ingesting casein protein hydrolysate-carbohydrate (PRO) compared with carbohydrate-only (CHO) during a 3-day mountain bike race.

METHODS

Eighteen male cyclists were randomly assigned to ingest 6.7% carbohydrate without (CHO) or with 1.3% casein hydrolysate (PRO) during racing (~ 4-5 h/day; 68/71/71 km). Conventional LV echocardiography, plasma albumin content, plasma volume (PV) and blood biomarkers were measured before day 1 and post race on day 3.

RESULTS

Fourteen cyclists (n = 7 per group) completed the race. PV increased in CHO (mean increase (95% CI), 10.2% (0.1 to 20.2)%, p = 0.045) but not in PRO (0.4% (- 6.1 to 6.9)%). Early diastolic transmitral blood flow (E) was unchanged but deceleration time from peak E increased post race (CHO: 46.7 (11.8 to 81.6) ms, p = 0.019; PRO: 24.2 (- 0.5 to 48.9) ms, p = 0.054), suggesting impaired LV relaxation. Tissue Doppler mitral annular velocity was unchanged in CHO, but in PRO septal early-to-late diastolic ratio decreased (p = 0.016) and was compensated by increased lateral early (p = 0.034) and late (p = 0.012) velocities. Systolic function was preserved in both groups; with increased systolic lateral wall velocity in PRO (p = 0.002). Effect size increase in serum creatine kinase (CK) activity, CK-MB and C-reactive protein concentrations was less in PRO than CHO (Cohen's d mean ± SD, PRO: 2.91 ± 2.07; CHO: 7.56 ± 4.81, p = 0.046).

CONCLUSION

Ingesting casein hydrolysate with carbohydrate during a 3-day race prevented secondary hypervolemia and failed to curb impaired LV relaxation despite reducing tissue damage and inflammatory biomarkers. Without PV expansion, systolic function was preserved by lateral wall compensating for septal wall dysfunction.

Troponin and exercise

Cardiac troponins are the preferred biomarkers in diagnostic of myocardial infarction, but these markers also can rise in response to exercise. Multiple studies have assessed troponins post-exercise, but the results have varied and there have been disagreements about the mechanism of troponin release. The aim of this paper was to review the literature, and to consider factors and mechanisms regarding exercise-induced increase of troponin. 145 studies were found after a search in pubmed and inclusion of additional articles found in the reference list of the first articles. Results showed that troponin rises in 0-100% of subjects after prolonged heavy exercise like marathon, but also after short-term and intermittent exercise like 30min of running and basketball. The variation can be due to factors like intensity, age, training experience, variation in sample size, blood sample timing and troponin assay. The pattern of troponin level post-exercise corresponds to release from the cytosolic compartment of cardiomyocytes. Increased membrane permeability might be caused by production of reactive oxygen species or alterations in calcium, pH, glucose/fat metabolism or in communication between integrins. Other suggested mechanisms are increased cardiovascular stress, inflammation, vasculitis, release of troponin degradation products in "blebs", dehydration, impaired renal clearance and expression of cardiac troponin in skeletal muscle. It can be concluded that both heavy and light exercise may cause elevated troponin, which have to be considered when patient are suspected to have a myocardial infarction. Several factors probably influence post-exercise levels of troponin, but the mechanism of release is most likely physiologic.

Comparison of energy supplements during prolonged exercise for maintenance of cardiac function: carbohydrate only versus carbohydrate plus whey or casein hydrolysate

Cardiac function is often suppressed following prolonged strenuous exercise and this may occur partly because of an energy deficit. This study compared left ventricular (LV) function by 2-dimensional echocardiography and tissue Doppler imaging (TDI) before and after ∼2.5 h of cycling (2-h steady-state 60% peak aerobic power output plus 16 km time trial) in 8 male cyclists when they ingested either placebo, carbohydrate-only (CHO-only), carbohydrate-casein hydrolysate (CHO-casein), or carbohydrate-whey hydrolysate (CHO-whey). No treatment-by-time interactions occurred, but pre-to-postexercise time effects occurred selectively. Although diastolic function measured by pulsed-wave Doppler early-to-late (E/A) transmitral blood flow velocity was suppressed in all trials from pre- to postexercise (mean change post-pre exercise: -0.53 (95% CI -0.15 to -0.91)), TDI early-to-late (e'/a') tissue velocity was significantly suppressed pre- to postexercise only with placebo, CHO-only, and CHO-whey (septal and lateral wall e'/a' average change: -0.62 (95% CI -1.12 to -0.12); -0.69 (95% CI -1.19 to -0.20); and -0.79 (95% CI -1.28 to -0.29), respectively) but not with CHO-casein (-0.40 (95% CI -0.90 to 0.09)). LV contractility was, or tended to be, significantly reduced pre- to postexercise with placebo, CHO-only, and CHO-whey (systolic blood pressure/end systolic volume change, mm Hg·mL(-1): -0.8 (95% CI -1.2 to -0.4), p = 0.0003; -0.5 (95% CI -0.9 to -0.02), p = 0.035; and -0.4 (95% CI -0.8 to 0.04), p = 0.086, respectively), but not with CHO-casein (-0.3 (95% CI -0.8 to 0.1), p = 0.22). However, ejection fraction (EF) and ventricular-arterial coupling were significantly reduced pre- to postexercise only with placebo (placebo change: EF, -4.6 (95% CI -8.4 to -0.7)%; stroke volume/end systolic volume, -0.3 (95% CI -0.6 to -0.04)). Despite no treatment-by-time interactions, pre-to-postexercise time effects observed with specific beverages may be meaningful for athletes. Tentatively, the order of beverages with least-to-most variables displaying a time effect indicating suppression of LV function following exercise was CHO-casein < CHO-only and CHO-whey < placebo, and calls for further verification.

Effect of prolonged walking on cardiac troponin levels

Increased cardiac troponin I (cTnI), a marker for cardiac damage, has been reported after strenuous exercise in young subjects. However, little is known about changes in cTnI after moderate-intensity exercise in a heterogenous population or which factors may contribute to this change in cTnI levels. We examined cTnI levels before and immediately after each day of a 4-day long-distance walking event (30 to 50 km/day) in a heterogenous group (67 men, 42 women), across a broad age range (21 to 82 years), with known cardiovascular pathology or risk factors present in many subjects (n = 24). Walking was performed at a self-selected pace. Cardiac TnI was assessed using a standard system (Immulite) with high values (>or=0.20 microg/L) cross-checked using a high-sensitive cTnI assay (Centaur). Mean cTnI levels increased significantly from 0.04 to 0.07 microg/L on day 1, with no further increase thereafter (p <0.001, analysis of variance). Backward linear regression found a weak, but significant, association of age (p <0.001), walking speed (p = 0.02), and cardiovascular pathology (p = 0.03) with postexercise cTnI level (combined r(2) = 0.11, p <0.001). In 6 participants (6%), cTnI was increased above the clinical cut-off value for myocardial infarction on >or=1 day. These participants supported the regression analysis, because they were older, walked at higher relative exercise intensity, and reported a high prevalence of cardiovascular pathology. In conclusion, prolonged, moderate-intensity exercise may result in an increase in cTnI levels in a broad spectrum of subjects, especially in older subjects with pre-existing cardiovascular disease or risk factors.