Exercise-induced cardiac troponin elevation: An update on the evidence, mechanism and implications

Abstract

Post-exercise cardiac troponin (cTn) elevation is a recognised phenomenon which historically has been detected using standard sensitivity assays. More recently high-sensitivity assays have been developed and are now the gold standard for detection of cTn in the clinical setting. Although the assay's enhanced sensitivity confers benefits it has created new challenges for clinicians. By evaluating the change in cTn values over time, taking into account biological and analytical variation, the clinician is able to differentiate between a pathological and normal cTn value. As a result, serial cTn testing has become a fundamental component of the clinical assessment of chest pain patients and is included in the most recent definition for myocardial infarction and the latest guidelines for the management of acute coronary syndromes without persistent ST-segment elevation. A review of the cTn kinetics literature demonstrates a pattern of elevation and peak within the first 4 h after exercise dropping within 24 h. In contrast myocardial necrosis demonstrates a later cTn peak with a slower downslope occurring over several days. Understanding cTn kinetics facilitates clinician's decision making when presented with a chest pain patient post-exercise. Furthermore, it helps elucidate the underlying mechanism and establish the clinical significance of post-exercise cTn elevation, which in all other situations confers negative prognostic value. We recommend serial cTn testing in this scenario with a suggested algorithm included in this review.

Cardiac Troponin T Release after Football 7 in Healthy Children and Adults

“…Our results are confirmatory of the acute elevation of cTnT in the hours after exercise [2]. As previously noticed in other studies [3,4], participants had normal ECG and reported no history of personal nor familiar cardiovascular disease.…”

“…The release of cardiac troponins (cTn), typically observed in patients with acute and chronic myocardial injury (MI), is also common in healthy athletes of all ages and training statuses after exercise [1,2]. This subject is potentially important for the triage of athletes who develop chest pain that mimics cardiac injury after exercise and who might have serum cardiac troponins drawn in the emergency room.…”

The impact of exercise modality and menstrual cycle phase on circulating cardiac troponin T

“…2,3 To date, the mechanism(s) and exact determinant(s) that mediate postexercise cTn elevation are poorly understood. 3,4 This knowledge can contribute to any clinical decision-making associated with exercise-induced cTn changes such as a visit of a patient to a medical department following a bout of exercise in which extreme https://doi.org/10.1016/j.jsams.2019.10.003 1440-2440/© 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.…”

“…Although little empirical data are available it has been widely speculated that exercise may cause reversible cardiomyocyte damage that temporarily increases the permeability of the cell membrane, leading to release of soluble cTn molecules from the cytosol. [2][3][4] Experimental studies have demonstrated that oestrogen can protect the heart from ischaemia-reperfusion injury such that cTnI is reduced. 6 It is thought that one of the ways in which oestrogen reduces myocardial damage and cTn release is a consequence of its antioxidant properties, which to help stabilise and protect the cell membrane.…”

Cardiac Biomarker Levels After a Football Match in Professional Versus Amateur Lithuanian Football Players

“…Cardiac troponins (cTn) have gained great importance among researchers because they are a key biomarker [1,2]. It is an established fact that many athletes after long-duration exercise have more than the upper reference limit (URL) release of cTn [3]. Some studies have also shown high values for cTn release among sportspersons, even for short-duration exercise [4], moderate duration [5], and continuous exercise [6].…”