Kinetics, Moderators and Reference Limits of Exercise-Induced Elevation of Cardiac Troponin T in Athletes: A Systematic Review and Meta-Analysis

Abstract

Background: Kinetics, moderators and reference limits for exercise-induced cardiac troponin T (cTnT) elevations are still unclear.Methods: A systematic review of published literature was conducted adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies reporting high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after a bout of exercise in athletes were included and analyzed. The final dataset consisted of 62 estimates from 16 bouts in 13 studies of 5–1,002 athletes (1,421 in total). Meta-analysis was performed using general linear mixed modeling and Bayesian inferences about effect magnitudes. Modifying fixed-effect moderators of gender, age, baseline level, exercise duration, intensity and modalities were investigated. Simulation was used to derive 99th percentile with 95% limits of upper reference ranges for hs-cTnT of athletic populations.Results: The mean and upper reference limits of hs-cTnT before exercise were 4.4 and 19 ng.L−1. Clear increases in hs-cTnT ranging from large to very large (factor changes of 2.1–7.5, 90% compatibility limits, ×/÷1.3) were evident from 0.7 through 25 h, peaking at 2.9 h after the midpoint of a 2.5-h bout of running, when the mean and upper reference limit for hs-cTnT were 33 and 390 ng L−1. A four-fold increase in exercise duration produced a large clear increase (2.4, ×/÷1.7) in post-exercise hs-cTnT. Rowing exercise demonstrated an extremely large clear reduction (0.1 ×/÷2.4).Conclusions: The kinetics of cTnT elevation following exercise, the positive effect of exercise duration, the impact of exercise modality and 99th upper reference limits for athletic populations were reasonably well defined by this meta-analysis.

Mountain Ultra-Marathon (UTMB) Impact on Usual and Emerging Cardiac Biomarkers

“…Several studies have already shown that the kinetics of the increase are similar to those observed during a cardiac event. However, the peak is always lower and the recovery is faster ( 11 , 12 ).…”

Effects of high-intensity interval exercise on cardiac troponin elevation when comparing with moderate-intensity continuous exercise: a systematic review and meta-analysis

“…In clinical settings, cardiac troponin increases sharply after irreversible damage, which is maintained for a long time ( Park et al, 2017 ). Nevertheless, the increase in cardiac troponin induced by exercise was different in terms of hemodynamic changes ( Li et al, 2021a ; Eijsvogels et al, 2015 ; Cirer-Sastre et al, 2021 ). Most studies have shown that the decrease from the peak occurred after 3–6 h following exercise ( Park et al, 2017 ; Eijsvogels et al, 2014 ; Hosseini et al, 2018 ; Eijsvogels et al, 2015 ; Chan-Dewar et al, 2013 ).…”

“…Overall intensity, duration, and exercise types are factors that affected the level of cardiac troponin after exercise ( Li et al, 2021a ; Takahashi & Miyamoto, 1998 ; Martínez-Navarro et al, 2020 ; Richardson et al, 2018 ). The differences were evident particularly in the comparison of exercise intensity such as between HIIE and MICE ( Weippert et al, 2016 ; Zhang et al, 2019 ).…”

Exercise Training Increases Serum Cardiac Troponin T Independent of Left Ventricular Mass

“…All participants were required to abstain from moderate or strenuous exercise for 48 h before the post-training test. The timing for the post-exercise blood samples was based on: 1) previous studies have shown that the cTnT elevation response to exercise is transient and cTnT generally returns to baseline within 48 hours post-exercise [23,24]; and 2) this is the longest resting time between two training sessions when training is performed 4 days per week; the cTnT values obtained may be considering baseline (resting) values during the structured training period.…”