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Cardiac biomarkers play an important role in the diagnosis of cardiovascular disease. Elevated levels can be seen in the context of strenuous exercise. We studied this phenomenon in senior endurance runners. We included 185 participants (61.1 +/- 5 years; 29% women) at a 30-km cross-country race who were self-reportedly in excellent health. Before and after the race, the creatinine, N-terminal pro-brain natriuretic peptide (NT-proBNP), and troponin T were analyzed, and participation in the number of previous races and the race duration were recorded. NT-proBNP increased from 53 ng/L (interquartile range 31 to 89) to 121 ng/L (interquartile range 79 to 184) and troponin T from undetectable to 0.01 microg/L (interquartile range 0.01 to 0.04). The independent predictors of a large NT-proBNP increase were (1) greater levels present at baseline, (2) a greater increase in creatinine (both p0.001), (3) older age (p = 0.01), and (4) a longer race duration (p0.05). Troponin T elevation was independently predicted by (1) older age (p = 0.01), (2) a greater increase in creatinine, and (3) participation in fewer previous races (both p0.05). Of the 15 runners with an elevated (194 ng/L) baseline NT-proBNP level (8.1% of 185), 4 were found to have serious cardiovascular disease (2.2% of whole sample). Of these 4 patients, 1 died from sudden cardiac death within months after the race. In conclusion, biomarker elevation occurs commonly in senior runners. A high baseline NT-proBNP is predictive of a large release during exercise, suggesting that the factors that control the at rest levels also determine its release with exertion. Troponin T elevation was seen in less-experienced participants. A small group of very ill runners were identified by NT-proBNP analysis.

Intermittent and chronic volume overload might contribute to the onset and progression of cardiovascular disease in patients who are undergoing maintenance hemodialysis (HD). Continuous monitoring of central hemodynamic variables may provide valuable information to improve volume control, particularly in patients with left ventricular dysfunction. Sixteen patients with end-stage renal disease who were undergoing long-term HD received an implantable hemodynamic monitor consisting of a subcutaneously implanted memory device and transvenous right ventricular (RV) lead with a pressure sensor. The implantable hemodynamic monitor continuously records heart rate, RV pressures, and estimated pulmonary arterial (PA) diastolic pressure, an estimate of left ventricular filling pressure. All patients underwent HD 3 times per week, and averages of rest hemodynamic values from the first, second, and third nights after HD during 12 weeks were analyzed. The third night always occurred after the weekend, when there was an extended interval between dialysis sessions. From the first night to the second night, RV systolic pressure increased by 10 ± 8% (p

Cardiac resynchronization therapy (CRT) devices not only deliver effective treatment but may also serve as valuable diagnostic tools in heart failure management. In the present study, the minutes of daily physical activity and heart rate variability, measured by sensors incorporated into such a device, reflected the effects of CRT and were related to New York Heart Association functional class.

Effects of biventricular pacing on myocardial blood flow and oxygen consumption using carbon-11 acetate positron emission tomography in patients with heart failure

To assess the impact of biventricular pacing on quality of life over 12 months of follow-up, 76 patients in the MUSTIC trial were evaluated by 2 instruments: The Minnesota Living with Heart Failure Questionnaire and the Karolinska Quality of Life Questionnaire. MUSTIC is a randomized, controlled study to evaluate the effects of biventricular pacing in patients in New York Heart Association class III heart failure with intraventricular conduction delay. Following a single, blind, crossover comparison of 3 months of biventricular pacing to inactive pacing (sinus rhythm group) or ventricular-inhibited pacing (atrial fibrillation group), 85% of patients preferred and were programmed to biventricular pacing and were followed for 12 months. In parallel with clinical improvements, substantial benefits in quality of life for most broad domains of quality of life and cardiovascular symptoms were found during biventricular pacing already within the crossover phase with a maintained benefit over the 12-month follow-up. Biventricular pacing improved quality of life in patients with heart failure and intraventricular conduction delays. The benefits were sustained over 12 months of follow-up.

Intermittent and chronic volume overload might contribute to the onset and progression of cardiovascular disease in patients who are undergoing maintenance hemodialysis (HD). Continuous monitoring of central hemodynamic variables may provide valuable information to improve volume control, particularly in patients with left ventricular dysfunction. Sixteen patients with end-stage renal disease who were undergoing long-term HD received an implantable hemodynamic monitor consisting of a subcutaneously implanted memory device and transvenous right ventricular (RV) lead with a pressure sensor. The implantable hemodynamic monitor continuously records heart rate, RV pressures, and estimated pulmonary arterial (PA) diastolic pressure, an estimate of left ventricular filling pressure. All patients underwent HD 3 times per week, and averages of rest hemodynamic values from the first, second, and third nights after HD during 12 weeks were analyzed. The third night always occurred after the weekend, when there was an extended interval between dialysis sessions. From the first night to the second night, RV systolic pressure increased by 10 +/- 8% (p0.001), and estimated PA diastolic pressure increased by 16 +/- 14% (p0.001). On the third night, RV systolic pressure increased by 14 +/- 12% (p0.001), and estimated PA diastolic pressure increased by 23 +/- 18% (p0.001) compared with the first night. In conclusion, the progressive pressure increments between dialysis sessions seen in this study suggest that the implantable hemodynamic monitor was a sensitive indicator for changes in volume load in patients who were undergoing HD treatment. The results also suggest that more frequent dialysis may avoid excessive pressure increase, but this needs to be investigated further in future studies.

Cardiac biomarker release after endurance exercise has been described in young athletes. Although older athletes are increasingly active in such sports, they have not previously been studied. Therefore, the aim of this study was to assess the magnitude and reproducibility of biomarker release in athletes agedor =55 years. Forty-three healthy athletes (mean age 61 +/- 3.6 years) were assessed before and immediately after a 30-km cross-country race and studied with echocardiography at rest. The median N-terminal pro-brain natriuretic peptide (NT-proBNP; normal194 ng/L) level was 42 ng/L (interquartile range 30 to 95) at baseline and 191 ng/L (interquartile range 114 to 308) after the race. Troponin T (normal0.03 microg/L) was elevated in 19 subjects (44%) after the race. Twenty-two subjects had also been studied 3 years before at the same race, using an identical test protocol. Between the 2 races, strong correlations were seen for individual runners' postrace biomarker levels (NT-proBNP: r = 0.82, log transformed data; troponin T: Spearman's rho = 0.84; p0.001 for both). The coefficient of variation for NT-proBNP release was 8.1%. Levels of NT-proBNP after the race were correlated with levels at baseline (r = 0.93, p0.001) and with left ventricular mass index (r = 0.32, p = 0.03). Moreover, participants with elevated postrace NT-proBNP were significantly older (62.0 vs 59.8 years, p = 0.04). In conclusion, long-distance runners agedor =55 years released NT-proBNP and troponin T in a reproducible fashion. The magnitude of NT-proBNP release during the race was correlated strongly with NT-proBNP baseline levels and was associated with left ventricular mass and age. These findings may suggest a potential adverse effect of long-distance running on cardiac function in certain participants in this age group.

Our objective was to evaluate the prognostic information of preprocedural serum N-terminus pro-brain natriuretic peptide (NT-pro-BNP) levels to predict the long-term outcome after percutaneous coronary intervention (PCI). A total of 891 consecutive patients with stable or unstable angina pectoris with normal serum troponin T levels (or =0.03 microg/L) undergoing PCI were investigated. For each patient with a cardiovascular event (death or nonfatal myocardial infarction), 2 event-free patients were used as controls. The procedure was successful in all patients, and follow-up was complete. By the end of the follow-up period (mean 2.6 years), 75 patients had had a cardiovascular event (41 deaths and 34 nonfatal myocardial infarctions). On multivariate analysis, lesion severity, diabetes mellitus, and NT-pro-BNP levels in the highest quartile (490 mg/L) were identified as independent factors for death or nonfatal myocardial infarction after PCI. In conclusion, preprocedural NT-pro-BNP levels are associated with long-term outcome after PCI. The use of NT-pro-BNP can be of value in risk stratification in patients undergoing PCI.