title: Elevation of serum N-terminal pro-brain natriuretic peptide after exercise is an index of myocardial damage or a cytoprotective reflection?
abstract: OBJECTIVE
  Recent investigations have suggested the occurrence of transient cardiac dysfunction and reversible myocardial injury in healthy individuals after heavy exercise. Our purpose was to examine if the release of N-terminal pro-brain natriuretic peptide (NT-proBNP) after intense exercise in obviously healthy participants may have cytoprotective and growth-regulating effects or may result from myocardial dysfunction/damage with changes in cTnT as a marker for myocardial cell necrosis during exercise.
  
  
  METHODS
  In 43 highly-trained male athletes <35 years old, who were examined immediately after exercising as well as 2 days later, 21 age-matched male patients classified as stage-B according to ACC/AHA guidelines and 35 healthy age-matched males, we evaluated NT-proBNP and 3rd generation's cTnT by electrochemiluminescence immunoassay. All participants underwent a detailed cardiac protocol including echocardiography and electrocardiogram (ECG).
  
  
  RESULTS
  In athletes, cTnT consistently remained <0.01 mg/L after exercising as well as after 2 days. NTproBNP immediately after exercising was 58.27+/-19.48 ng/L, without reaching pathological levels, decreasing 2 days later to 22.93+/-10.22 ng/L. Our patients maintained high levels of NTproBNP, as much as a six-fold increase with reference to the levels of our study's control group and with cTnT <0.01 mg/L. In the control group, cTnT and NTproBNP levels were statistically similar with those of the athletes 2 days after exercising. NT-proBNP as a biological marker can reliably discriminate pathological from physiological cardiac hypertrophy.
  
  
  CONCLUSIONS
  A normal plasma concentration of NT-proBNP in consecutive routine check-up, before and after exercise, could minimize the possibility of cardiac dysfunction, whereas persistent elevated plasma concentrations warrant further cardiological evaluation.
authors.affiliation: Department of Clinical Biochemistry, Medical School, University of Athens, Attikon University Hospital, Athens, Greece. efaviou@in.gr
authors.forename: E
authors.initials: E
authors.lastname: Faviou
authors.forename: A
authors.initials: A
authors.lastname: Zachari
authors.forename: C
authors.initials: C
authors.lastname: Nounopoulos
authors.forename: E
authors.initials: E
authors.lastname: Agrafiotis
authors.forename: G
authors.initials: G
authors.lastname: Vourli
authors.forename: A
authors.initials: A
authors.lastname: Dionyssiou-Asteriou
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D019610:Cytoprotection; D015444:Exercise / Q000502:physiology*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D010806:Physical Education and Training; D010809:Physical Fitness; D010865:Pilot Projects; D013178:Sports Medicine; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain