Changes of resting cardiac marker levels due to sport adaptation

Background In acute and chronic heart diseases some cardiac necroenzymes and peptide fragments are essential during the diagnosis and following the progression of the diseases. Previous literature data are available about elevation of these cardiac markers after exhausting physical activity, but we do not have information about the resting levels in athletes. Methods In part of the extended cardiology screening of athletes in our institute, we analyzed the levels of hsTroponinT, CKMB, LDH and NT-proBNP from blood samples. All the samples were collected at least 12 hours after the last trainings or competitions. The results of the athletes were compared with a healthy sedentary non-athlete control group. After the blood collection all subject underwent echocardiography examinations and cardiopulmonary exercise testing. Depending on normality, groups were compared with two-tailed Student's t-test or Mann-Whitney U-test. Statistical analysis was processed in RStudio development environment. Results Results of 335 athletes from different sports (male: 162, age: 18.9±5.9 years, training: 15.8±5.9 hours/week) and 53 sedentary non-athletes (male: 23, age: 19.8±3.2 years, training: 2.7±2.3 hours/week) were compared. In athletes, increased level of hsTroponinT was found in 3.3% (n=11), of CKMB in 5.7% (n=18), of LDH in 2.7% (n=9) and of NT-proBNP in 1.2% (n=4). In the control group no elevation was found regarding the CKMB and hsTroponinT, while slightly elevated values of LDH and NT-proBNP were revealed in 1–1 cases. In athletes we measured higher CKMB (17.5±6.8 vs 12.3±3.4 U/l, p<0.001) and LDH values (323.7±63.3 vs 286.0±51.1 U/l, p<0.001), and lower values of NT-proBNP (27.2±29.2 vs 49 8±38.7 pg/ml, p<0.001) compared to the control group, while in the hsTroponinT levels (4.3±1.4 vs 5.6±6.3 ng/l, p=0.33) no significant changes were measured. In term of the examined laboratory parameters significant correlation was found with maximal relative aerob capacity (CKMB: r=0.23, p<0.001; LDH: r=0.18, p<0.001; hsTroponinT: r=0.23, p<0.001; NT-proBNP: r=−0.22, p<0.001), but no correlation was found with age. Significant correlation was found between NT-proBNP levels and echocardiographic measurements of ventricular diameters and left ventricular wall thickness (LVEDD r=−0.15, p<0.03; LVESD r=−0.18, p<0.03; RVD: r=−0.15, p<0.02; IVS: r=−0.22, p<0.001; PWD r=−0.27, p<0.001), CKMB levels correlated with left ventricular wall thickness (IVS: r=0.11, p<0.05; PWD r=0.14, p<0.02). Conclusions Based on our results, in connection with the sports adaptation of the heart, the resting levels of the cardiac markers also show significant changes, these changes are correlated with aerobic endurance and structural sport adaptation parameters as well. Our study draws attention to the importance of different assessment of cardiac markers in athletes. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This project was supported by a grant from the National Research, Development and Innovation Office (NKFIH) of Hungary (K 135076).Supported by the ÚNKP-20-3-I-SE-41 New National Excellence Program of the Ministry for Innovation and Technology from the Source of the National Research, Development and Innovation fund.

Discordant clinical features of identical hypertrophic cardiomyopathy twins

Hypertrophic cardiomyopathy (HCM) is a disease of heart muscle, which affects ∼1 in 500 individuals and is characterized by increased left ventricular wall thickness. While HCM is caused by pathogenic variants in any one of eight sarcomere protein genes, clinical expression varies considerably, even among patients with the same pathogenic variant. To determine whether background genetic variation or environmental factors drive these differences, we studied disease progression in 11 pairs of monozygotic HCM twins. The twin pairs were followed for 5 to 14 y, and left ventricular wall thickness, left atrial diameter, and left ventricular ejection fraction were collected from echocardiograms at various time points. All nine twin pairs with sarcomere protein gene variants and two with unknown disease etiologies had discordant morphologic features of the heart, demonstrating the influence of nonhereditable factors on clinical expression of HCM. Whole genome sequencing analysis of the six monozygotic twins with discordant HCM phenotypes did not reveal notable somatic genetic variants that might explain their clinical differences. Discordant cardiac morphology of identical twins highlights a significant role for epigenetics and environment in HCM disease progression.

P1281CLINICAL CHARACTERISTICS OF OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME IN MAINTENANCE HEMODIALYSIS PATIENTS

Background and Aims To explore the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) in maintenance hemodialysis patients. Method 42 patients with maintenance hemodialysis in our hemodialysis center from April 2019 to December 2019 were enrolled for night-time sleep breathing monitoring. The patients were divided into the OSAHS group(n=25) and the non-OSAHS group(n=17) defined by AHI. The OSAHS group was further divided into a mild group (n=14) and a moderate-severe group (n=11). The clinical datas, sleep breathing monitoring datas, and echocardiographic parameters of the OSAHS group and the non-OSAHS group, the mild OSAHS group, and the moderate-severe OSAHS group were compared. Results 1. There were no differences in gender, age, dialysis age, spKt / V, BMI, TBW, ECW, ICW, E / I ratio, Ca, P, HB, and diastolic blood pressure between the the OSAHS group and the non-OSAHS group. 2. Incidence of left ventricular concentric hypertrophy (84.0% VS 47.1%, P = 0.011), left ventricular wall thickness (12.0 VS 10.2, P = 0.029) and systolic blood pressure (147.0 ± 9.6 VS 139.4 ± 13.8, P = 0.041) ) in OSAHS group was significantly higher than the non-OSAHS group; 3: There was no statistical difference in serum carbon dioxide binding capacity (CO2CP) between the two groups (23.1 ± 2.7 VS 23.8 ± 2.6, P = 0.392), but the daily intake of sodium bicarbonate in the OSAHS group was higher than that of the non-OSAHS group (2.5 ± 1.0 VS 1.5 ± 0.5, P = 0.004); the CO2CP of the moderate-severe OSAHS group was lower than that of the mild group (21.7 ± 2.2 VS 24.2 ± 2.7, P = 0.019 ), the left ventricular wall thickness was significantly higher than the mild group (11.4 ± 1.4 VS 12.6 ± 1.1, P = 0.025). Conclusion Clinicians should pay attention to the early diagnosis and prevention of OSAHS in maintenance hemodialysis patients. Because the dialysis population is different from the general population of OSAHS patients, the serum CO2CP of this population is negatively correlated with the degree of OSAHS, and clinicians need to pay particular attention to the amount of sodium bicarbonate to correct acidosis.