Constant and intense physical activity causes physiological adaptive changes in the human body, but it can also become a trigger for adverse events, such as sudden cardiac arrest or sudden cardiac death. Our main objective was to assess the use of combined cardiopulmonary exercise testing (CPET) and cardiac biomarker determinants in young professional athletes. We conducted a study which involved the full examination of 19 football players, all male, aged between 18 and 20 years old. They underwent standard clinical and paraclinical evaluation, a 12-lead electrocardiogram (ECG), and transthoracic echocardiography (TTE). Afterwards, a tailored CPET was performed and peripheral venous blood samples were taken before and 3 h after the test in order to determine five biomarker levels at rest and post-effort. The measured biomarkers were cardiac troponin I (cTnI), myoglobin (Myo), the MB isoenzyme of creatine-kinase (CK-MB), the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and D-dimers. While cTnI and NT-proBNP levels were undetectable both at rest and post-effort in all subjects, the variations in Myo, CK-MB and D-dimers showed significant correlations with CPET parameters. This highlights the potential use of combined CPET and biomarker determinants to evaluate professional athletes, and encourages further research on larger study groups.

The research of biomarkers continues to emerge as a developing academic field which is attracting substantial interest. The study of biomarkers proves to be useful in developing and implementing new screening methods for a wide variety of diseases including in the sports area, whether for leisure activities or professional sports. Novel research has brought into question the immune system and the limitations it may impose on sports practicing. As the well-being of athletes is a priority, the state of their immune function offers valuable information regarding their health status and their ability to continue training. The assessment of various biomarkers may contribute to a more accurate risk stratification and subsequent prevention of some invalidating or even fatal pathologies such as the sudden cardiac death. Therefore, we have reviewed several studies that included sports-related pathology or specific morphofunctional alterations for which some immune biomarkers may represent an expression of the underlying mechanism. These include the defensins, immunoglobulin A (IgA), interleukin-6 (IL-6), the tumoral necrosis factor α (TNF-α), and the white blood cells (WBC) count. Similarly, also of significant interest are various endocrine biomarkers, such as cortisol and testosterone, as well as anabolic or catabolic markers, respectively. Literature data highlight that these values are greatly influenced not only by the duration, but also by the intensity of the physical exercise; moderate training sessions actually enhance the immune function of the body, while a significant increase in both duration and intensity of sports activity acts as a deleterious factor. Therefore, in this paper we aim to highlight the importance of biomarkers’ evaluation in connection with sports activities and a subsequent more adequate approach towards personalized training regimens.

Background: In STEMIs, the evaluation of the relationship between biomarkers of myocardial injury and patients’ prognoses has not been completely explored. Increased levels of CK-MB in patients with a STEMI undergoing primary angioplasty are known to be associated with higher mortality rates, yet the correlation of these values with short-term evolution remains unknown. Material and Methods: The research encompassed a sample of 80 patients diagnosed with STEMIs, and its methodology entailed a retrospective analysis of the data collected during their hospital stays. The study population was then categorized into three distinct analysis groups based on the occurrence or absence of acute complications and fatalities. Results: The findings indicated that there is a notable correlation between rising levels of CK-MB upon admission and peak CK-MB levels with a reduction in left ventricular ejection fraction. Moreover, the CK-MB variation established a point of reference for anticipating complications at 388 U/L, and a cut-off value for predicting death at 354 U/L. Conclusion: CK-MB values are reliable indicators of the progress of patients with STEMIs. Furthermore, the difference between the peak and admission CK-MB levels demonstrates a high accuracy of predicting complications and has a significant predictive power to estimate mortality risk.

Background: Device-detected subclinical atrial fibrillation (SCAF) and atrial high-rate episodes (AHRE) are increasingly recognized in patients with cardiac implantable electronic devices and through long-term rhythm monitoring. Although often asymptomatic, these episodes are associated with a higher risk of clinical atrial fibrillation (AF), stroke, and heart failure. Aims: This narrative review summarizes clinical, electrocardiographic, echocardiographic, and circulating biomarkers associated with the development and progression of device-detected SCAF/AHRE. Methods: We performed a comprehensive search of PubMed, Embase, and Scopus using combinations of the terms “subclinical atrial fibrillation”, “atrial high-rate episodes”, “device-detected AF”, “predictive factors”, “P-wave morphology”, “echocardiographic parameters”, “left atrial strain”, and “biological markers”. We included English-language-only studies of patients with cardiac implantable electronic devices or long-term monitoring and reporting incident SCAF/AHRE or AF as outcomes, published in the last 10 years. Results: Older age, high body mass index, heart failure, obstructive sleep apnea, and C₂HEST score are consistently associated with SCAF. On-surface electrocardiogram (ECG) and device electrograms, prolonged and dispersed P-wave indices, low atrial sensing amplitude, and specific pacing configurations, particularly right ventricular apical pacing with wide QRS, predict incident and longer-lasting AHRE. Echocardiographic markers of atrial cardiomyopathy, including increased left atrial volume and impaired atrial strain, together with indices of left ventricular diastolic dysfunction, further refine risk. Among circulating biomarkers, galectin-3 and high-sensitivity C-reactive protein show the most reproducible associations with incident AHRE. Conclusions: A multiparametric approach combining clinical profile, ECG features, advanced echocardiography, and selected biomarkers may improve identification of patients at risk for device-detected SCAF. Further prospective studies are needed to define risk thresholds that justify intensified rhythm surveillance and early initiation of anticoagulation or rhythm control strategies, especially in AHRE shorter than 24 h.