Raised troponin T and echocardiographic abnormalities after prolonged strenuous exercise—the Australian Ironman Triathlon

Abstract

Background: There is concern about whether cardiac damage occurs as a result of prolonged strenuous exercise. Objective: To investigate whether competing in a triathlon is associated with cardiac damage based on a sustained increase in cardiac troponin T (cTnT), and whether such an increase correlates with echocardiographic changes Methods: cTnT and echocardiographic measurements were made in 38 participants in the 2001 Australian ironman triathlon. cTnT was measured the day before, immediately after, and the day following the race. Echocardiography was done the day before, immediately after, and two to six weeks later for measurement of ejection fraction, stroke volume, cardiac output, wall motion analysis, and global left ventricular function (LVF). Results: No subject had detectable cTnT in the pre-race sample. Following the race, 32 subjects (86.5%) had detectable levels of cTnT (.0.01 ng/ml), with six (16.2%) having .0.10 ng/ml. The day after the race, nine subjects (23.7%) still had detectable cTnT, with two recording a level .0.10 ng/ml. Previously described echocardiographic changes of ''cardiac fatigue'' were observed in the whole cohort. There was a modest but significant correlation between change in ejection fraction and peak cTnT level (p = 0.02, r = 0.39). Athletes with a post-race cTnT .0.10 ng/ml had a greater decrease in global LVF (p = 0.02) and a trend toward a greater fall in ejection fraction and stroke volume than athletes with cTnT levels ,0.10 ng/ml. Cardiac output fell in the group with cTnT .0.10 ng/ml (p.0.05). Conclusions: Participation in ironman triathlon often resulted in persistently raised cTnT levels, and the troponin rise was associated with echocardiographic evidence of abnormal left ventricular function. The clinical significance and long term sequelae of such damage remains to be determined.

Exercise-Induced Right Ventricular Dysplasia/Cardiomyopathy—An Emerging Condition Distinct from Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

“…In a similar study 86% of athletes had detectable serum troponin levels after completing an ironman event. 6 These studies indicate that myocardial damage, albeit small, is common after such events. Furthermore, the RV appears more susceptible than the LV.…”

Exertional heat stroke in a young man with a documented rise in troponin I

“…In 2002, troponin I levels were measured in runners participating in the London marathon but no significant change in troponin levels was found between blood samples taken before and after the race 7. However, an Australian study of triathlon runners found persistently raised troponin T levels in the competitors 1 day after the race which later normalised 8. Despite the raised troponin level seen in ironman triathletes after events, no documented raised troponin levels in exertional heat stroke have been reported in the literature.…”

Exercise-Induced Cardiac Troponin Elevation

“…This sustained increase in cardiac work stresses the myocardium, which in conjunction with the physiologic milieu of prolonged exercise (e.g., elevations in reactive oxygen species, altered ph, and increased core temperature) could hypothetically damage cardiomyocytes. Troponin levels from participants in marathon-distance (4,36 -38) and ultra-distance foot races (39,40), triathlons (sequential swimming, cycling, and running) (3,41), and dedicated cycling events (42,43) have each been studied.…”