Periodic Reporting for period 1 - CARDI-ACHE (The cardiovascular consequences of endurance exercise)
Reporting period: 2015-06-01 to 2017-05-31
CARDI-ACHE aimed to elucidate the clinical relevance of these observations. More specifically, we assessed (1) the prognostic value of exercise-induced cardiac biomarker release, (2) the functional consequences of myocardial scarring was assessed in an athletic population, and (3) the potential association between cardiomyocyte damage and markers of cardiac scar tissue.
These studies are important as the uptake of endurance exercisers is rapidly increasing across Europe and the world and this is set against a backdrop where the popular media frequently cover the potential harmful effects of endurance exercise in a largely unbalanced fashion. These alternative facts may stimulate the general population to continue their unhealthy and sedentary lifestyle and prevent exercise adoption of any sort. Consequently our research seeks to provide important new novel information that has a broad-based impact on individuals undertaking endurance exercise through to public health policy makers.
CARDI-ACHE revealed that exercise-induced increases in cardiac biomarkers are highly variable across individuals, and partially depend on exercise intensity and health status. Adverse event rate was yet too low to perform statistical analyses, but will be repeated in the near future. Presence of myocardial scarring did not affect global cardiac function, although regional dysfunction was observed in co-localized scar tissue. Finally, biomarkers of myocardial scarring significantly increased following exercise, though no association was found with markers for cardiomyocyte damage. Taken together, the cardiac ‘maladaptations’ that are typically observed in lifelong athletes presumably have only minor clinical significance. These findings align with previous studies that report a superior life expectancy in athletes compared to the general population and support the concept that Exercise is Medicine.
I recruited a population of middle aged (45-55 yrs) and older (>65 yrs) athletes with a documented history of lifelong endurance exercise exposure to take part in a study about the athlete’s heart and the presence of cardiac dysfunction and/or myocardial fibrosis. For this purpose I have initiated a collaboration with CMR experts Dr’s Cooper and Fairburn from the Liverpool Heart and Chest Hospital. Extensive cardiac imaging was performed in athletes with and without cardiac scarring (WP-3). This allowed me to compare cardiac structure and function between both sub-groups. I found that global cardiac function was not affected in athletes with cardiac scarring, but regional dysfunction was present in areas with co-localized scar tissue. Finally we are currently analysing follow-up scans in the same athletes addressing the issue of progression, regression or development of new fibrosis over time and more exercise exposure in a sub-sample of these athletes. This data will be reported after completion of on-going CMR and echocardiographic image analysis.
Finally, I’ve selected samples from a cohort of marathon runners to perform biomarker analyses of cardiomyocyte damage and cardiac scarring (WP-4). Laboratory analyses were performed for baseline and post-exercise samples in 82 endurance runners. I found significant increases in both biomarkers but absolute concentrations or changes in biomarker levels for damage and fibrosis were not associated with each other. Hence, the present study did not uncover evidence for a direct link between cardiomyocyte damage and cardiac scarring.
Findings from CARDI-ACHE have been published in several scientific peer-reviewed journals (see project publications). Outcomes were also disseminated via social media and press releases so I could target a larger audience and also the general population. I have had the opportunity to share CARDI-ACHE results at several international conferences and interviews with lay press. Finally, there are numerous outputs and communication opportunities to come to showcase remaining CARDI-ACHE data and disseminate this information to diverse populations.