The Confounding Effects of Non-cardiac Pathologies on the Interpretation of Cardiac Biomarkers.

PURPOSE OF REVIEW: Cardiac biomarkers play important roles in routine evaluation of cardiac patients. But while these biomarkers can be extremely valuable, none of them should ever be used by themselves-without adding the clinical context. This paper explores the non-cardiac pathologies that can be seen with the cardiac biomarkers most commonly used. RECENT FINDINGS: High-sensitivity troponin assay gained FDA approval for use in the USA, and studies demonstrated its diagnostic utility can be extended to patients with renal impairment. Gender-specific cut points may be utilized for high-sensitivity troponin assays. In the realm of the natriuretic peptides, studies demonstrated states of natriuretic peptide deficiency in obesity and in subjects of African-American race. Regardless, BNP and NT-proBNP both retained prognostic utilities across a variety of comorbid conditions. We are rapidly gaining clinical evidence with use of soluble ST2 and procalcitonin levels in management of cardiac disease states. In order to get the most utility from their measurement, one must be aware of non-cardiac pathologies that may affect the levels of biomarkers as although many of these are actually true values, they may not represent the disease we are trying to delineate. A few take-home points are as follows: 1. A biomarker value should never be used without clinical context 2. Serial sampling of biomarkers is often helpful 3. Panels of biomarkers may be valuable.

[Cardiac rehabilitation and its sporty face]. / A szívbetegek rehabilitációjának sportos arca.

The prognosis of cardiac and other diseases is highly determined by the level of cardiopulmonary fitness (aerobic capacity). The main purposes of rehabilitative activities include the restoration and increase of VO2max. The "classic" method is the continuous aerobic exercise (moderate-intensity continuous exercise). The higher increase of aerobic capacity in a shorter time can be developed by interval loads: shorter or longer active periods are interspersed by low-intensity rest periods. A recent form is the high-intensity interval training: 0.5-4 minutes on 70-90% of the aerobic capacity followed by a rest or low-intensity biking/walking/jogging/any activity. The sprint interval training uses a few ten seconds of maximal intensity bursts changed with longer low-intensity activities. The advantages of the interval methods are shorter training time, less monotony, higher efficiency with not more risks. Interval training methods are applied also in other pathologies without disadvantages. Orv Hetil. 2018; 159(33): 1346-1352.