Relação entre elevação da troponina cardíaca no plasma e exercício físico em indivíduos saudáveis
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Data
2022-12-01
Autores
Okada, Michelli
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O complexo de troponina cardíaca está presente na maquinaria contrátil do músculo cardíaco, responsável pela contração das fibras cardíacas em resposta ao cálcio intracelular. O aumento da concentração de troponinas cardíacas na circulação sanguínea é encontrado em casos de lesão ou necrose miocárdica observadas em doenças cardiovasculares. Entretanto, este aumento também é visto em indivíduos saudáveis após a prática de exercícios físicos de diferentes modalidades e intensidades. Objetivo: Entender o papel biológico e relevância clínica do aumento da troponina cardíaca no plasma em resposta ao exercício físico, em indivíduos saudáveis, e sua relação com aspectos tais como modalidade, intensidade e duração a fim de responder à questão “Qual a relação entre a elevação da troponina cardíaca no plasma e exercício físico em indivíduos saudáveis”. Métodos: Foi realizada uma revisão integrativa de literatura, utilizando os descritores “cardiac troponin”, “exercise”, e “healthy subjects”, juntamente com o operador booleano “AND” nas bases de dado PubMed e Google Acadêmico. Resultados: Foram incluídos 20 artigos, com base nos critérios, dos quais buscou-se a relação entre elevação da troponina cardíaca no plasma e exercício físico em indivíduos que não possuíssem nenhuma doença cardíaca crônica. Discussão: A cinética do aumento da troponina cardíaca em indivíduos saudáveis após exercício físico se dá precocemente e decai rapidamente dentro das primeiras 24 horas, distinguindo-se daquela observada em necrose cardíaca a qual aumenta mais lentamente e pode perdurar por até 2 semanas. Os fatores relacionados neste aumento envolvem a intensidade do exercício físico, os estágios iniciais de Tanner em adolescentes, sexo masculino e a privação de sono. Os mecanismos e causas da liberação parecem estar envolvidos com: 1) o aumento da permeabilidade do sarcolema por estresse mecânico, reação inflamatória mediada por proteínas C-reativas, aumento de lactato e radicais livres; 2) formação de bolhas no sarcolema em resposta à isquemia cardíaca por abreviação da diástole. As limitações apresentadas nos artigos envolvem a não padronização dos métodos de quantificação das troponinas, da mensuração da intensidade dos exercícios e da repercussão em longo prazo sobre episódios repetidos de exercício e elevação das troponinas. Conclusão: O aumento da troponina cardíaca em indivíduos saudáveis após exercício físico parece estar relacionada a uma resposta fisiológica do organismo, sendo importante o conhecimento do biomédico para uma melhor análise laboratorial evitando a emissão de laudos falso-positivos sem relevância para a clínica. As hipóteses sobre os mecanismos de liberação ainda estão em debate e estudos futuros são necessários para a observação dos efeitos em longo prazo.
Introduction: The cardiac troponin complex is present in the contractile machinery of the cardiac muscle, responsible for the contraction of cardiac fibers in response to intracellular calcium. The increased concentration of cardiac troponins in the bloodstream is found in cases of myocardial injury or necrosis observed in cardiovascular diseases. However, this increase is also seen in healthy individuals after the practice of physical exercises in different modalities and intensities. Objective: To understand the biological role and clinical relevance behind the increase in cardiac troponin in plasma and its relation with aspects such as modality, intensity and duration of physical exercise in order to answer the question “What is the relation between the increased concentration of cardiac troponin in plasma and physical exercise in healthy individuals”. Methods: An integrative literature review was performed, using the descriptors “cardiac troponin”, “exercise”, and “healthy subjects”, along with the Boolean operator “AND” in the PubMed and Google Scholar databases. Results: 20 articles were included, based on the criteria, from which the relation between the increase of cardiac troponin in plasma and physical exercise in individuals who did not have any chronic disease was sought. Discussion: The kinetics of the increase in cardiac troponin in healthy individuals after physical exercise occurs early and decreases rapidly within the first 24 hours, differing from that observed in cardiac necrosis, which increases more slowly and can last for up to 2 weeks. The factors related to this increase involve the intensity of physical exercise, the early stages in Tanner scale in adolescents, male sex and sleep deprivation. The mechanisms and causes underlying troponin release seem to be involved with: 1) increased permeability of the sarcolemma by mechanical stress, inflammatory reaction mediated by C-reactive proteins, increased lactate and free radicals; 2) formation of blebs in the sarcolemma in response to cardiac ischemia by shortening diastole. The limitations presented in the articles involve the non-standardization of troponin quantification methods, the measurement of exercise intensity and the long-term repercussions on repeated episodes of exercise and troponin elevation. Conclusion: The increase in cardiac troponin in healthy individuals after physical exercise seems to be related to a physiological response of the organism, being important the knowledge by the biomedical for a better laboratory analysis avoiding the issuance of false-positive reports without clinical relevance. Hypotheses about release mechanisms are still under debate and future studies are needed to observe long-term effects.
Introduction: The cardiac troponin complex is present in the contractile machinery of the cardiac muscle, responsible for the contraction of cardiac fibers in response to intracellular calcium. The increased concentration of cardiac troponins in the bloodstream is found in cases of myocardial injury or necrosis observed in cardiovascular diseases. However, this increase is also seen in healthy individuals after the practice of physical exercises in different modalities and intensities. Objective: To understand the biological role and clinical relevance behind the increase in cardiac troponin in plasma and its relation with aspects such as modality, intensity and duration of physical exercise in order to answer the question “What is the relation between the increased concentration of cardiac troponin in plasma and physical exercise in healthy individuals”. Methods: An integrative literature review was performed, using the descriptors “cardiac troponin”, “exercise”, and “healthy subjects”, along with the Boolean operator “AND” in the PubMed and Google Scholar databases. Results: 20 articles were included, based on the criteria, from which the relation between the increase of cardiac troponin in plasma and physical exercise in individuals who did not have any chronic disease was sought. Discussion: The kinetics of the increase in cardiac troponin in healthy individuals after physical exercise occurs early and decreases rapidly within the first 24 hours, differing from that observed in cardiac necrosis, which increases more slowly and can last for up to 2 weeks. The factors related to this increase involve the intensity of physical exercise, the early stages in Tanner scale in adolescents, male sex and sleep deprivation. The mechanisms and causes underlying troponin release seem to be involved with: 1) increased permeability of the sarcolemma by mechanical stress, inflammatory reaction mediated by C-reactive proteins, increased lactate and free radicals; 2) formation of blebs in the sarcolemma in response to cardiac ischemia by shortening diastole. The limitations presented in the articles involve the non-standardization of troponin quantification methods, the measurement of exercise intensity and the long-term repercussions on repeated episodes of exercise and troponin elevation. Conclusion: The increase in cardiac troponin in healthy individuals after physical exercise seems to be related to a physiological response of the organism, being important the knowledge by the biomedical for a better laboratory analysis avoiding the issuance of false-positive reports without clinical relevance. Hypotheses about release mechanisms are still under debate and future studies are needed to observe long-term effects.
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Marcadores Bioquímicos, Cardiologia, Fisiologia, Exercícios físicos