Exercise-induced Changes in Soluble ST2 Concentrations in Marathon Runners

Abstract

Purpose: Previous studies have suggested that extreme endurance exercise may induce cardiac microdamage that could lead to subsequent myocardial fibrosis. Soluble suppression of tumorigenicity 2 (sST2) is a cardiac biomarker for assessment of myocardial fibrosis, inflammation, and strain. We evaluated baseline and exercise-induced sST2 concentrations in a heterogeneous cohort of marathon runners to identify predictors for sST2 concentrations.

Methods: Ninety-two runners supplied demographic data, health status, physical activity levels, and marathon experience. Before (baseline) and immediately after (finish) the marathon, blood was collected for analysis of sST2 and cardiac troponin I (cTnI).

Results: Eighty-two participants (45 ± 8 yr, 79% male) finished the race in 227 ± 28 min at 92% (88%-94%) of their predicted maximum heart rate (exercise intensity). sST2 concentrations increased in all runners, from 34 (25-46) ng·mL to 70 (53-87) ng·mL (P < 0.001), and cTnI increased from 9 (5-21) ng·L to 60 (34-102) ng·L (P < 0.001). sST2 concentrations were higher in the fastest marathon runners. Sex and marathon personal best time were associated with baseline sST2 (R = 0.27); baseline sST2, weight loss, and exercise intensity during marathon were associated with finish sST2 (R = 0.54); baseline sST2, height, sex, and weekly training hours were associated with the exercise-induced increase in sST2 (R = 0.47). We observed no association between sST2 and cTnI concentrations.

Conclusion: An exercise-induced increase in sST2 was observed in all marathon runners with sST2 concentrations exceeding cutoff values both at baseline (48%) and finish (94%). Faster runners had higher sST2 concentrations. Our data suggest complex variables determine sST2 concentrations in marathon runners.

FIGURE 1

Frequency distribution of ΔsST2. Every runner shows an increase in sST2 concentration.

FIGURE 2

sST2 concentrations in the fastest 50% vs slowest 50% of the cohort based on marathon personal best time. Dotted line shows the cutoff value for sST2 (35 ng·mL⁻¹). Data are shown as median with interquartile range.