Occult obstructive coronary artery disease is associated with prolonged cardiac troponin elevation following strenuous exercise

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Sudden cardiac death among middle-aged recreational athletes is predominantly due to myocardial ischaemia. This study examined whether measuring cardiac troponin I and T (cTnI and cTnT) after strenuous exercise could identify occult obstructive coronary artery disease. </jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p> Prospective observational study. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Subjects were recruited from 1002 asymptomatic recreational cyclists completing a 91-km mountain bike race (North Sea Race Endurance Exercise Study). No subject had known cardiovascular disease or took cardiovascular medication. Blood samples were collected within 24 h before and 3 h and 24 h after the race. Coronary computed tomography angiography was performed in 80 participants with the highest post-exercise cTnI and in 40 reference subjects with moderately elevated cTnI values. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Study subjects ( N = 120) were 45 (36–52) years old and 74% were male. There were similar demographics in the High-cTnI group and the Reference group. The cTn concentrations were highest at 3 h post-race: cTnI, 224 (125–304) ng/L; cTnT, 89 (55–124) ng/L. Nine subjects had obstructive coronary artery disease on coronary computed tomography angiography, eight of whom were High-cTnI responders. Two subjects had myocardial bridging, both High-cTnI responders. Troponin concentrations at 24 h post-race were higher in subjects with obstructive coronary artery disease than in the rest of the cohort ( n = 109): cTnI, 151 (72–233) ng/L vs. 24 (19–82) ng/L, p = 0.005; cTnT, 39 (25–55) ng/L vs. 20 (14–31) ng/L, p = 0.002. The areas under the receiver operating characteristic curves for predicting obstructive coronary artery disease were 0.79, p = 0.005 (cTnI) and 0.82, p = 0.002 (cTnT). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> In subjects with occult obstructive coronary artery disease there was a prolonged elevation of cTn following strenuous exercise. </jats:p></jats:sec>

Endurance exercise training volume is not associated with progression of coronary artery calcification

“…New CAC in 2018 occurred in six subjects with no CAC at baseline (Table 2). The median Δ CAC in these subjects was 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) Agatston units. The only subject with a CAC progression exceeding 10 Agatston units (CAC of 20 Agatston units in 2018) was a 37-year-old male with a non-calcified plaque on the baseline CCTA examination in 2014.…”

“…The present analysis is a sub-study of the North Sea Race Endurance Exercise Study (NEEDED) 2018. We assessed the change in CAC between the baseline CCTA acquired in either the NEEDED 2013 or 2014 study 7,8 and the follow-up CCTA assessment in 2018 ( Figure S1). NEEDED 2018 was approved by the Regional Ethics Committee (REK 2013/550 and REK 2018/63), in compliance with the Declaration of Helsinki.…”

“…44 ± 9 years old, P = .002) and had a higher FRS (4 [1][2][3][4][5][6][7][8][9][10][11][12] vs 0 [0-2] %, P = .007) and higher levels of low-density lipoprotein (LDL) (3.5 [2.9-4.3] vs 2.9 [2.3-3.5] mmol/L, P = .031). None of the included subjects were current smokers at inclusion, and a similar number of subjects in both groups had a history of tobacco use (P = .78).…”

Differential associations of cardiac troponin T and cardiac troponin I with coronary artery pathology and dynamics in response to short-duration exercise

“…Further, our study did not include serial sampling of cTn concentrations, and as such does not contain the information needed to opine on the temporal release patterns observed in other studies. [23,25] Obtaining a single post-exercise sample is a clinically desirable practice, as prompt sampling eliminates the need for prolonged observation. However, it is evident that the temporal aspect of cTn release is important and the lack of such data is a limitation to our study.…”

“…A value of two corresponds to a doubling relative to resting cTn concentrations.The median (Q1-3) absolute change in hs-cTnT concentrations was 0 (0-1) ng/L, corresponding to relative change of 5 (0-12) %, p<0.001. Six (2%) patients had ≥2-fold increase (from median 5 (Q1-3 3-8) ng/L to 20(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) ng/L).…”