Duration of Elevated Heart Rate Is an Important Predictor of Exercise‐Induced Troponin Elevation

Bjørkavoll-Bergseth, Magnus; Kleiven, Øyunn; Auestad, Bjørn; Eftestøl, Trygve; Oskal, Kay Raymond Jenssen; Nygård, Martin; Skadberg, Øyvind; Aakre, Kristin Moberg; Melberg, Tor; Gjesdal, Knut; Ørn, Stein

doi:10.1161/jaha.119.014408

Cited by 23 publications

(24 citation statements)

References 25 publications

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“…Also, a field study among 177 cyclists participating in a 91-km mountain bike race showed that the time spent performing high-intensity exercise (heart rate >150 bpm) was an independent predictor of postexercise cTnI and cTnT concentrations. 30 In aggregate, these data suggest that postexercise cTn elevations are related to overall cardiac workload, the product of both duration and intensity.…”

Section: Exercise-induced Cardiac Troponin Elevationsmentioning

confidence: 84%

Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance

et al. 2021

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Serological assessment of cardiac troponins (cTn) is the gold standard to assess myocardial injury in clinical practice. A greater magnitude of acutely or chronically elevated cTn concentrations is associated with lower event-free survival in patients and the general population. Exercise training is known to improve cardiovascular function and promote longevity, but exercise can produce an acute rise in cTn concentrations, which may exceed the upper reference limit in a substantial number of individuals. Whether exercise-induced cTn elevations are attributable to a physiological or pathological response and if they are clinically relevant has been debated for decades. Thus far, exercise-induced cTn elevations have been viewed as the only benign form of cTn elevations. However, recent studies report intriguing findings that shed new light on the underlying mechanisms and clinical relevance of exercise-induced cTn elevations. We will review the biochemical characteristics of cTn assays, key factors determining the magnitude of postexercise cTn concentrations, the release kinetics, underlying mechanisms causing and contributing to exercise-induced cTn release, and the clinical relevance of exercise-induced cTn elevations. We will also explain the association with cardiac function, correlates with (subclinical) cardiovascular diseases and exercise-induced cTn elevations predictive value for future cardiovascular events. Last, we will provide recommendations for interpretation of these findings and provide direction for future research in this field.

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Section: Exercise-induced Cardiac Troponin Elevationsmentioning

confidence: 84%

Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance

et al. 2021

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“…Third, the late elevation of creatine kinase and myoglobin from skeletal muscle after high-load, long duration exercise is mirrored by the cTnT and cTnI elevations observed in young athletes [17] , [38] . Participants in extreme races often develop troponin elevations that are ten times the assay specific cutoff's that become more prominent after long bouts of exercise [39] and is related to duration of elevated heart rates [40] . Most studies have not excluded necrotic events, but necrosis is unlikely to be the only release mechanism as most participants that develop troponin elevations are young and fit.…”

Section: Discussionmentioning

confidence: 99%

The ratio of cardiac troponin T to troponin I may indicate non-necrotic troponin release among COVID-19 patients

Hammarsten

Ljungqvist

Redfors

et al. 2022

Clinica Chimica Acta

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Background Although cardiac troponin T (cTnT) and troponin I(cTnI) are expressed to similar amount in cardiac tissue, cTnI often reach ten-times higher peak levels compared to cTnT in patients with myocardial necrosis such as in acute myocardial infarction (MI). In contrast, similar levels of cTnT and cTnI are observed in other situations such as stable atrial fibrillation and after strenuous exercise. Objective Examine cTnT and cTnI levels in relation to COVID-19 disease and MI. Methods Clinical and laboratory data from the local hospital from an observational cohort study of 27 patients admitted with COVID-19 and 15 patients with myocardial infarction (MI) that were analyzed with paired cTnT and cTnI measurement during hospital care. Results Levels of cTnI were lower than cTnT in COVID-19 patients (TnI/TnT ratio 0.3, IQR: 0.1-0.6). In contrast, levels of cTnI were 11 times higher compared to cTnT in 15 patients with MI (TnI/TnT ratio 11, IQR: 7-14). The peak cTnI/cTnT ratio among the patients with MI following successful percutaneous intervention were 14 (TnI/TnT ratio 14, IQR: 12-23). The 5 COVID-19 patient samples collected under possible necrotic events had a cTnI/cTnT ratio of 5,5 (IQR: 1,9-8,3). Conclusions In patients with COVID-19, cTnT is often elevated to higher levels than cTnI in sharp contrast to patients with MI, indicating that the release of cardiac troponin has a different cause in COVID-19 patients.

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“…At similar average heart rates during exercise, hs-cTn changed more severely following intermittent exercise with higher maximal heart rates (Li et al, 2020 ). The duration of exercise above certain threshold heart rates therefore seemed to play an important role in hs-cTn elevation (Bjørkavoll-Bergseth et al, 2020 ), so more research on the effects of exercise intensity is obviously needed.…”

Section: Discussionmentioning

confidence: 99%

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

Hopkins

Wang

et al. 2021

Front. Physiol.

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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.

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Duration of Elevated Heart Rate Is an Important Predictor of Exercise‐Induced Troponin Elevation

Cited by 23 publications

References 25 publications

Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance

Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance

The ratio of cardiac troponin T to troponin I may indicate non-necrotic troponin release among COVID-19 patients

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

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