Relationship between Inflammatory Cytokines and Indices of Cardiac Dysfunction following Intense Endurance Exercise

Abstract

ObjectivesPro-inflammatory cytokines have been noted to increase following exercise but their relationship to exercise-induced cardiac dysfunction has not previously been investigated. We sought to evaluate whether exercise-induced cardiac dysfunction was associated with increases in cytokines, particularly the pro-inflammatory cytokines IL-1β, IL-12p70 and TNFα, which have been most implicated in cardiac pathology.Methods40 well-trained endurance athletes underwent evaluation prior to and immediately following one of four endurance sporting events ranging from 3 to 11 hours duration. Cytokines (IL-1β, IL-6, IL-8, IL-10, IL-12p70 and TNFα) were analyzed by flow cytometry from serum samples collected within 50 minutes of race completion. Cardiac troponin (cTnI) and B-type natriuretic peptide were combined with an echocardiographic assessment of cardiac function, and a composite of cTnI > 0.04 μg/L, BNP increase > 10 ng/L and a decrease in right ventricular ejection (RVEF) > 10% were prospectively defined as evidence of myocardial dysfunction.ResultsRelative to baseline, IL-6 IL-8 and IL-10 increased 8.5-, 2.9-, and 7.1-fold, respectively, P<0.0001. Thirty-one (78%), 19 (48%) and 18 (45%) of the athletes met the pre-specified criteria for significant cTnI, BNP and RVEF changes, respectively. TNFα, IL-12p70 were univariate predictors of ΔRVEF and ΔBNP whilst none of the anti-inflammatory cytokines were significantly associated with these measures. Ten athletes (25%, all athletes competing in the endurance event of longest duration) met criteria for exercise-induced myocardial dysfunction. In these 10 athletes with myocardial dysfunction, as compared to those without, there was significantly greater post-race expression of the pro-inflammatory cytokines IL-12p70 (8.1±3.8pg/ml vs. 2.5±2.6pg/ml, P<0.0001) and TNFα (6.5±3.1pg/ml vs. 2.0±2.5pg/ml, P<0.0001).ConclusionCardiac dysfunction following intense endurance exercise was associated with increased expression of pro-inflammatory cytokines. This does not prove a causal relationship but provides rationale for further investigations into whether inflammation mediates exercise-induced myocardial dysfunction.

Physical activity and exercise attenuate neuroinflammation in neurological diseases

“…Another caveat involves observations that intense prolonged and strenuous exercise, in many cases, is associated with increased markers of inflammation and cellular damage (Comassi et al, 2015). For example, La Gerche et al found that intense endurance exercise (3 to 11 hours in duration) in trained subjects correlated with dramatic increases in serum IL-6, IL-8, IL-10 and TNF-α concentrations (La Gerche et al, 2015).…”

Intensive exercise and its effect on the heart: Is more always better?

“…A significant increase in cardiac troponin and B-type natriuretic peptide (BNP) levels observed immediately after exertion, indicated myocardial damage and were correlated with echocardiographic RV systolic dysfunction [11].…”

“…Previous studies indicated a role of proinflammatory cytokines in heart failure (endothelin-1, tumor necrosis factor-[TNF]-alpha) [16,17] and in the risk of CV adverse events (interleukin [IL]-6, TNF-alpha) [18]. Recently, La Gerche et al [19] were the first to show that myocardial dysfunction secondary to intense endurance exercise (as evidenced by elevated cardiac troponin and BNP levels along with a reduction in RV ejection fraction) was associated with increased blood levels of proinflammatory cytokines including TNF-alpha and IL-12p70i. Taking into account known effects of these cytokines, it may be suspected that repeated intensive physical exercise and associated inflammatory reactions may lead to fibrosis.…”

Monitoring Morphologic Changes in Male Rowers Using Limited Portable Echocardiography Performed by a Frontline Physician

“…Sports medicine providers and organizations could use limited echocardiography to optimize athletes' performance and health. A growing body of evidence suggests that the relationship between the exercise dose and cardiovascular health is a U‐shaped curve: extremely low and extremely high exercise doses appear to negatively affect cardiovascular health . Implementation of limited echocardiography would allow sports medicine providers to monitor individual athletes' responses to exercise.…”