High-Sensitive Troponin Testing and the “Runner's Syndrome”

Lippi, Giuseppe; Plebani, Mario

doi:10.1016/j.jemermed.2009.07.005

Cited by 6 publications

(2 citation statements)

References 13 publications

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“…Moreover, recent data suggest that strenuous endurance exercise improves life expectancy (Ruiz et al 2011). Therefore, it is tempting to suggest that the appearance of cTnI after physical exercise does not reflect a clinically threatening (irreversible) myocardial injury, but rather may reflect a reversible increase in cellular membrane permeability and rapid troponin release from the cytosolic pool post-exercise (Lippi and Plebani 2009). Some authors have suggested that exercise-induced cTn release reflects the activation of cellular cascades that result in cardiac hypertrophy (Scharhag et al 2006).…”

Section: Discussionmentioning

confidence: 99%

The impact of exercise intensity on the release of cardiac biomarkers in marathon runners

et al. 2011

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We sought to determine the influence of exercise intensity on the release of cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in amateur marathon runners. Fourteen runners completed three exercise trials of the same duration but at exercise intensities corresponding to: (a) a competitive marathon [mean ± SD: heart rate 159 ± 7 beat min(-1), finish time 202 ± 14 min]; (b) 95% of individual anaerobic threshold [heart rate 144 ± 6 beat min(-1)] and; (c) 85% of individual anaerobic threshold [heart rate 129 ± 5 beat min(-1)]. cTnI and NT-proBNP were assayed from blood samples collected before, 30 min and 3 h post-exercise for each trial. cTnI and NT-proBNP were not different at baseline before each trial. After exercise at 85% of individual anaerobic threshold cTnI was not significantly elevated. Conversely, cTnI was elevated after exercise at 95% of individual anaerobic threshold (0.016 μg L(-1)) and to an even greater extent after exercise at competition intensity (0.054 μg L(-1)). Peak post-exercise values of NT-proBNP were elevated to a similar extent after all exercise trials (P < 0.05). The upper reference limit for cTnI (0.04 μg L(-1)) was exceeded in six subjects at competition intensity. No data for NT-proBNP surpassed its upper reference limit. Peak post-exercise values for cTnI and NT-proBNP were correlated with their respective baseline values. These data suggest exercise intensity influences the release of cTnI, but not NT-proBNP, and that competitive marathon running intensity is required for cTnI to be elevated over its upper reference limit.

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Section: Discussionmentioning

confidence: 99%

The impact of exercise intensity on the release of cardiac biomarkers in marathon runners

et al. 2011

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“…Increased levels of cTn or hsTn after prolonged or strenuous exercise have been widely studied (7, 16, 17, 18, 19, 20, 21). The assessment of small changes in troponins is possible by using modern hsTn analytical procedures, whereas the older generations of analytic kits for troponin analysis were not sensitive enough to detect small changes, even after extreme exercise (5, 22).…”

Section: Discussionmentioning

confidence: 99%

High-Sensitivity Troponins after a Standardized 2-Hour Treadmill Run

Brož¹,

Rajdl²,

Novák³

et al. 2018

Journal of Medical Biochemistry

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SummaryBackgroundThe aim of this study was to examine high-sensitivity troponin T and I (hsTnT and hsTnI) after a treadmill run under laboratory conditions and to find a possible connection with echocardiographic, laboratory and other assessed parameters.MethodsNineteen trained men underwent a standardized 2-hour-long treadmill run. Concentrations of hsTnT and hsTnI were assessed before the run, 60, 120 and 180 minutes after the start and 24 hours after the run. Changes in troponins were tested using non-parametric analysis of variance (ANOVA). The multiple linear regression model was used to find the explanatory variables for hsTnT and hsTnI changes. Values of troponins were evaluated using the 0h/1h algorithm.ResultsChanges in hsTnT and hsTnI levels were statistically significant (p<0.0001 and p<0.0001, respectively). In a multiple regression model (adjusted R2: 0.60, p=0.005 for hsTnT and adjusted R2: 0.60, p=0.005 for hsTnI), changes in both troponins can be explained by relative left wall thickness (LV), training volume, body temperature after the run and creatinine changes. According to the 0h/1h algorithm, none of the runners was evaluated as negative.ConclusionsRelative LV wall thickness, creatinine changes, training volume and body temperature after the run can predict changes in hsTnT and hsTnI levels. When medical attention is needed after physical exercise, hsTn levels should be tested only when clinical suspicion and the patient’s history indicate a high probability of myocardial damage.

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Comparison of conventional and highly-sensitive troponin I measurement in ultra-marathon runners

Lippi

Schena

Salvagno

et al. 2011

J Thromb Thrombolysis

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Cardiac troponins are a mainstay in the diagnostic approach of patients with suspected acute coronary syndrome. Along with other causes of cardiac injury, strenuous aerobic exercise is an important source of troponin leakage from myocardium. Due to recent immunoassays development, there is no information on variation of highly-sensitive (HS) troponin I (TnI) in ultra-marathon runners. We studied 15 healthy trained Caucasian athletes before and immediately after completion of a 60 km, ultra-marathon. TnI was measured with both the conventional AccuTnI and the novel HS-AccuTnI immunoassays. At the end of the ultra-marathon the concentration of HS-AccuTnI significantly increased from the baseline value (19.2 ± 4.2 vs. 5.2 ± 0.8 ng/l; P = 0.001). The number of athletes displaying HS-AccuTnI values exceeding the 99th percentile of the reference limit was 2 (13%) pre-exercise, increasing significantly to 12 (80%; P < 0.001) post-exercise. Measurable value of AccuTnI were found in 1 (7%) and 12 (80%; P < 0.001) athletes pre- and post exercise, respectively. All AccuTnI values were below the 99th percentile reference limit pre-exercise, whereas this cut-off was overcome in 20% of athletes, post-exercise. These results suggest that the myocardium release of TnI during strenuous aerobic exercise mirrors that of troponin T. Moreover, the improved sensitivity of the HS-AccuTnI over the conventional assay makes it more suited for detecting even minor elevations of TnI in blood.

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High-Sensitive Troponin Testing and the “Runner's Syndrome”

Cited by 6 publications

References 13 publications

The impact of exercise intensity on the release of cardiac biomarkers in marathon runners

The impact of exercise intensity on the release of cardiac biomarkers in marathon runners

High-Sensitivity Troponins after a Standardized 2-Hour Treadmill Run

Comparison of conventional and highly-sensitive troponin I measurement in ultra-marathon runners

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