Post-exercise high-sensitivity troponin T levels in patients with suspected unstable angina

Lanza, Gaetano Antonio; Mencarelli, Erica; Melita, Veronica; Tota, Antonio; Gabrielli, Maurizio; Sarullo, Filippo M.; Cordischi, Chiara; Potenza, Angelo Eugenio; Cardone, Silvia; Vita, Antonio De; Bisignani, Antonio; Manfredonia, Laura; Caccamo, Giuseppa; Vitale, Giuseppe; Baroni, Silvia; Antenucci, Mirca; Crea, Filippo; Franceschi, Francesco

doi:10.1371/journal.pone.0222230

Cited by 9 publications

(17 citation statements)

References 25 publications

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“…However, a higher myocardial work and oxygen consumption, as indicated by higher HR levels achieved during EST, tended to be associated with a higher TnI increase. Although not statistically significant, this finding is in agreement with a similar recent observation in patients admitted with a diagnosis of suspected unstable angina, 18 thus suggesting that myocardial metabolism is a major determinant of troponin release during exercise.…”

Section: Discussionsupporting

confidence: 91%

Postexercise troponin I levels in patients with suspected stable ischemic heart disease

Lanza

Morgante

Melita

et al. 2020

Journal of Cardiovascular Medicine

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Background and aims Previous studies showed that troponin blood levels may increase after exercise. In this study, we assessed whether, among patients with suspected of having stable angina, the increase in troponin I (TnI) levels after exercise stress test (EST) might help identify those with obstructive coronary artery disease (CAD) and myocardial ischemia. Methods We performed maximal treadmill EST in 50 patients (age 64 ± 9 years; 38 men) admitted to our Cardiology Department to undergo elective coronary angiography because of a suspicion of stable angina. TnI was measured before and 12 h after EST. Results TnI increased after EST compared with baseline in the whole population (from 0.44 ± 0.76 to 0.84 ± 1.12 ng/dl, P < 0.001). No difference in TnI increase was observed between patients with obstructive CAD (n = 29; 0.61 ± 0.90–1.13 ± 1.33 ng/dl) and no obstructive CAD (NO-CAD; n = 21; 0.21 ± 0.46–0.44 ± 0.54 ng/dl; P = 0.51). There was also no significant difference in post-EST TnI increase between patients with positive EST (n = 34; 0.56 ± 0.89–1.05 ± 1.28 ng/dl) or negative EST (n = 16; 0.19 ± 0.26–0.39 ± 0.43 ng/dl; P = 0.16). Moreover, no significant difference was observed in the post-EST TnI increase among groups of patients with positive EST and obstructive CAD, positive EST and NO-CAD, negative EST and obstructive CAD and negative EST and NO-CAD (P = 0.12). No clinical or EST variable was associated with post-EST TnI increase, although there was a tendency for a greater increase in those achieving a heart rate more than 85 vs. less than 85% of maximal predicted heart rate during EST (P = 0.075). Conclusion TnI increase after EST in patients with suspected stable angina is largely independent of the results of coronary angiography and EST.

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Section: Discussionsupporting

confidence: 91%

Postexercise troponin I levels in patients with suspected stable ischemic heart disease

Lanza

Morgante

Melita

et al. 2020

Journal of Cardiovascular Medicine

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“…There was no difference in 4 hours postexercise cTnT concentrations between patients with unstable angina who did (n=23) or did not (n=46) develop recurrent angina at 6-month follow-up. 80 Another study reported no difference in the incidence of a composite end point (death, myocardial infarction, acute revascularization, hospitalization for unstable angina, or heart failure) in patients with CAD with 8 to 12 and 24-hour postexercise cTnI concentrations greater than versus less than the URL (27% versus 17%, P >0.05) during 36 (15–49) months of follow up. 81 The absence of an association of exercise cTn with subsequent symptoms may be attributable to the short duration of exercise, sample size, sampling times, only a small number of clinical events, or the absence of a clinically important relationship.…”

Section: Clinical Relevancementioning

confidence: 98%

“…However, cTn concentrations taken at rest in large populations and clinical studies predict mortality and cardiovascular morbidity, 2 , 4 even within the normal range. 3 The prognostic value of exercise-induced increases in cTn has rarely been studied 80 , 81 but may have clinical relevance in some populations as discussed later on in this article.…”

Section: Clinical Relevancementioning

confidence: 99%

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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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“…Although regular exercise reduces the risk of cardiovascular diseases, some studies have reported acute coronary syndrome and even sudden cardiac death related to sports activities (2). Some other studies have also reported elevations in cardiac damage biomarkers after prolonged exercise (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Cardiac Troponin Elevation After Long-Distance Cycling is Associated with Oxidative Stress and Exercise Intensity: An Observational Study

et al. 2020

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Background: To date, the mechanisms of post-exercise cardiac troponin elevation are debatable. Previous studies have reported that oxidative stress happens after extended exercise. Objectives: This study purposed to establish the association between the elevation of malondialdehyde (MDA), which is a marker of oxidative stress, and cardiac troponin-I (cTn-I) after prolonged cycling. Methods: Ninety-two males in Indonesian cycling tours participated in the present study. Baseline and post-exercise blood specimens were obtained to define MDA and cTn-I levels. The elevations of MDA and cTn-I were determined as positive differences of post-cycling MDA and cTn-I levels to the baseline, respectively. Results: Eighty-eight participants (age, mean = 45.3 years old, [SD]:11.47; body mass index (BMI), mean=24.2 kg/m2, [SD]: 3.03) finished the cycling tours. Subjects’ characteristics were comparable based on the touring category, except for the family history of coronary artery disease, high-density lipoprotein cholesterol level, neutrophil count, resting heart rate, exercise intensity, and cTn-I elevation. MDA significantly escalated at the level of 210.90 µmol/mL at post-exercise, from 190.18 µmol/mL at baseline. cTn-I also increased at the level of 13.65 ng/dL from 5.16 ng/dL. The elevation of MDA was related to the elevation of cTn-I. Elevation of cTn-I after prolonged cycling was contributed by elevation of MDA and exercise intensity. Conclusions: The present findings support existing confirmation that cTn-I elevation after prolonged exercise is related to oxidative stress and exercise intensity.

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Post-exercise high-sensitivity troponin T levels in patients with suspected unstable angina

Cited by 9 publications

References 25 publications

Postexercise troponin I levels in patients with suspected stable ischemic heart disease

Postexercise troponin I levels in patients with suspected stable ischemic heart disease

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

Cardiac Troponin Elevation After Long-Distance Cycling is Associated with Oxidative Stress and Exercise Intensity: An Observational Study

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