Exercise-induced cardiac troponin elevation: Evidence, mechanisms, and implications

Journal of the American College of Cardiology

Volumn 56, Issue 3, 2010, Pages 169-176

  Shave, Rob ^a   Baggish, Aaron ^b   George, Keith ^c   Wood, Malissa ^b   Scharhag, Jurgen ^d   Whyte, Gregory ^c   Gaze, David ^a,e   Thompson, Paul D ^f  

^a BRUNEL UNIVERSITY   (United Kingdom)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

^c LIVERPOOL JOHN MOORES UNIVERSITY   (United Kingdom)

^d UNIVERSITY OF POTSDAM   (Germany)

^e ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST   (United Kingdom)

^f HARTFORD HOSPITAL   (United States)

Author keywords

ACS; acute coronary syndrome; cardiac troponin; cardiac troponin I; cardiac troponin T; CK MB; creatine kinase myocardial band; cTn; cTnI; cTnT

Indexed keywords

TROPONIN C; BIOLOGICAL MARKER; TROPONIN;

CELL DEATH; CELL MEMBRANE PERMEABILITY; EXERCISE; HEART FUNCTION; HEART MUSCLE CELL; HUMAN; PATHOPHYSIOLOGY; PREVALENCE; PRIORITY JOURNAL; PROTEIN BLOOD LEVEL; PROTEIN FUNCTION; PROTEIN SECRETION; PROTEIN STRUCTURE; REVIEW; SARCOLEMMA; HEART MUSCLE; METABOLISM;

BIOLOGICAL MARKERS; EXERCISE; HUMANS; MYOCARDIUM; TROPONIN;

EID: 77955059630     PISSN: 07351097     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.jacc.2010.03.037     Document Type: Review

References (72)

1. I.M. Lee, J.E. Manson, C.H. Hennekens, and R.S. Paffenbarger Jr Body weight and mortality A 27-year follow-up of middle-aged men JAMA 270 1993 2823 2828
2. N. Middleton, K. George, G. Whyte, D. Gaze, P. Collinson, and R. Shave Cardiac troponin T release is stimulated by endurance exercise in healthy humans J Am Coll Cardiol 52 2008 1813 1814
3. N. Rifai, P.S. Douglas, M. O'Toole, E. Rimm, and G.S. Ginsburg Cardiac troponin T and I, echocardiographic [correction of electrocardiographic] wall motion analyses, and ejection fractions in athletes participating in the Hawaii Ironman Triathlon Am J Cardiol 83 1999 1085 1089
4. T.G. Neilan, J.L. Januzzi, and E. Lee-Lewandrowski Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon Circulation 114 2006 2325 2333
5. R.E. Shave, G.P. Whyte, K. George, D.C. Gaze, and P.O. Collinson Prolonged exercise should be considered alongside typical symptoms of acute myocardial infarction when evaluating increases in cardiac troponin T Heart 91 2005 1219 1220
6. P.O. Collinson, F.G. Boa, and D.C. Gaze Measurement of cardiac troponins Ann Clin Biochem 38 2001 423 449
7. K. Thygesen, J.S. Alpert, and H.D. White Universal definition of myocardial infarction J Am Coll Cardiol 50 2007 2173 2195 (Pubitemid 350123680)
8. A. Jeremias, and C.M. Gibson Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded Ann Intern Med 142 2005 786 791
9. K. Thygesen, J.S. Alpert, and H.D. White Universal definition of myocardial infarction Circulation 116 2007 2634 2653 (Pubitemid 350182388)
10. S. James, P. Armstrong, and R. Califf Troponin T levels and risk of 30-day outcomes in patients with the acute coronary syndrome: prospective verification in the GUSTO-IV trial Am J Med 115 2003 178 184
11. C. Becattini, M.C. Vedovati, and G. Agnelli Prognostic value of troponins in acute pulmonary embolism: a meta-analysis Circulation 116 2007 427 433
12. G. Whyte, N. Stephens, and R. Senior Treat the patient not the blood test: the implications of an increase in cardiac troponin after prolonged endurance exercise Br J Sports Med 41 2007 613 615 discussion 615
13. J. Bleier, K.P. Vorderwinkler, and J. Falkensammer Different intracellular compartmentations of cardiac troponins and myosin heavy chains: a causal connection to their different early release after myocardial damage Clin Chem 44 1998 1912 1918
14. J.H. Mar, R.C. Iannello, and C.P. Ordahl Cardiac troponin T gene expression in muscle Symp Soc Exp Biol 46 1992 237 249
15. C.J. Sutherland, K.A. Esser, V.L. Elsom, M.L. Gordon, and E.C. Hardeman Identification of a program of contractile protein gene expression initiated upon skeletal muscle differentiation Dev Dyn 196 1993 25 36
16. P.A. Anderson, N.N. Malouf, A.E. Oakeley, E.D. Pagani, and P.D. Allen Troponin T isoform expression in humans A comparison among normal and failing adult heart, fetal heart, and adult and fetal skeletal muscle Circ Res 69 1991 1226 1233
17. T.A. Cooper, and C.P. Ordahl A single troponin T gene regulated by different programs in cardiac and skeletal muscle development Science 226 1984 979 982
18. J.E. Humphreys, and P. Cummins Regulatory proteins of the myocardium Atrial and ventricular tropomyosin and troponin-I in the developing and adult bovine and human heart J Mol Cell Cardiol 16 1984 643 657
19. S. Sasse, N.J. Brand, and P. Kyprianou Troponin I gene expression during human cardiac development and in end-stage heart failure Circ Res 72 1993 932 938
20. A.H. Wu, Y.J. Feng, and R. Moore Characterization of cardiac troponin subunit release into serum after acute myocardial infarction and comparison of assays for troponin T and I American Association for Clinical Chemistry Subcommittee on cTnI Standardization Clin Chem 44 1998 1198 1208
21. A.H. Wu, and L. Ford Release of cardiac troponin in acute coronary syndromes: ischemia or necrosis? Clin Chim Acta 284 1999 161 174
22. H.A. Katus, A. Remppis, T. Scheffold, K.W. Diederich, and W. Kuebler Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction Am J Cardiol 67 1991 1360 1367
23. P.O. Collinson, and P.J. Stubbs Are troponins confusing? Heart 89 2003 1285 1287
24. G.J. Fulda, F. Giberson, D. Hailstone, A. Law, and M. Stillabower An evaluation of serum troponin T and signal-averaged electrocardiography in predicting electrocardiographic abnormalities after blunt chest trauma J Trauma 43 1997 304 310 discussion 3102
25. M. Keel, and C. Meier Chest injurieswhat is new? Curr Opin Crit Care 13 2007 674 679
26. M.A. Baig, S. Ali, and M.U. Khan Cardiac troponin I release in non-ischemic reversible myocardial injury from parvovirus B19 myocarditis Int J Cardiol 113 2006 E109 E110
27. D.C. Gaze, and P.O. Collinson Cardiac troponins as biomarkers of drug- and toxin-induced cardiac toxicity and cardioprotection Expert Opin Drug Metab Toxicol 1 2005 715 725
28. A.J. Siegel, L.M. Silverman, and B.L. Holman Elevated creatine kinase MB isoenzyme levels in marathon runners Normal myocardial scintigrams suggest noncardiac source JAMA 246 1981 2049 2051
29. F.S. Apple, M.A. Rogers, W.M. Sherman, D.L. Costill, F.C. Hagerman, and J.L. Ivy Profile of creatine kinase isoenzymes in skeletal muscles of marathon runners Clin Chem 30 1984 413 416
30. P.D. Thompson, F.S. Apple, and A. Wu Marathoner's heart? Circulation 114 2006 2306 2308
31. A.J. Siegel, L.M. Silverman, and W.J. Evans Elevated skeletal muscle creatine kinase MB isoenzyme levels in marathon runners JAMA 250 1983 2835 2837
32. R. Shave, E. Dawson, and G. Whyte The cardiospecificity of the third-generation cTnT assay after exercise-induced muscle damage Med Sci Sports Exerc 34 2002 651 654
33. A.H. Wu, R. Valdes Jr., and F.S. Apple Cardiac troponin-T immunoassay for diagnosis of acute myocardial infarction Clin Chem 40 1994 900 907
34. A.J. Siegel, K.B. Lewandrowski, H.W. Strauss, A.J. Fischman, and T. Yasuda Normal post-race antimyosin myocardial scintigraphy in asymptomatic marathon runners with elevated serum creatine kinase MB isoenzyme and troponin T levels Evidence against silent myocardial cell necrosis Cardiology 86 1995 451 456
35. T. Keller, T. Zeller, and D. Peetz Sensitive troponin I assay in early diagnosis of acute myocardial infarction N Engl J Med 361 2009 868 877
36. A. Mingels, L. Jacobs, E. Michielsen, J. Swaanenburg, W. Wodzig, and M. van Dieijen-Visser Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays Clin Chem 55 2009 101 108
37. E.B. Fortescue, A.Y. Shin, and D.S. Greenes Cardiac troponin increases among runners in the Boston Marathon Ann Emerg Med 49 2007 137 143 143.e1
38. N. Mousavi, A. Czarnecki, and K. Kumar Relation of biomarkers and cardiac magnetic resonance imaging after marathon running Am J Cardiol 103 2009 1467 1472
39. R.E. Shave, E. Dawson, and G. Whyte Evidence of exercise-induced cardiac dysfunction and elevated cTnT in separate cohorts competing in an ultra-endurance mountain marathon race Int J Sports Med 23 2002 489 494
40. K. George, R. Shave, and D. Oxborough Left ventricular wall segment motion after ultra-endurance exercise in humans assessed by myocardial speckle tracking Eur J Echocardiogr 10 2009 238 243
41. L. Tulloh, D. Robinson, and A. Patel Raised troponin T and echocardiographic abnormalities after prolonged strenuous exercisethe Australian Ironman Triathlon Br J Sports Med 40 2006 605 609
42. J. Scharhag, M. Herrmann, A. Urhausen, M. Haschke, W. Herrmann, and W. Kindermann Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise Am Heart J 150 2005 1128 1134
43. G. Neumayr, R. Pfister, G. Mitterbauer, G. Eibl, and H. Hoertnagl Effect of competitive marathon cycling on plasma N-terminal pro-brain natriuretic peptide and cardiac troponin T in healthy recreational cyclists Am J Cardiol 96 2005 732 735
44. A.J. Siegel, J.J. Stec, and I. Lipinska Effect of marathon running on inflammatory and hemostatic markers Am J Cardiol 88 2001 918 920
45. G. Lippi, F. Schena, and G.L. Salvagno Influence of a half-marathon run on NT-proBNP and troponin T Clin Lab 54 2008 251 254
46. A.J. Saenz, E. Lee-Lewandrowski, and M.J. Wood Measurement of a plasma stroke biomarker panel and cardiac troponin T in marathon runners before and after the 2005 Boston marathon Am J Clin Pathol 126 2006 185 189
47. R. Shave, K.P. George, and G. Atkinson Exercise-induced cardiac troponin T release: a meta-analysis Med Sci Sports Exerc 39 2007 2099 2106
48. T. Eijsvogels, K. George, and R. Shave Effect of prolonged walking on cardiac troponin levels Am J Cardiol 105 2010 267 272
49. D.S. Jassal, D. Moffat, and J. Krahn Cardiac injury markers in non-elite marathon runners Int J Sports Med 30 2009 75 79
50. J.M. Scott, B.T. Esch, R. Shave, D.E. Warburton, D. Gaze, and K. George Cardiovascular consequences of completing a 160-km ultramarathon Med Sci Sports Exerc 41 2009 26 34
51. E. Giannitsis, H.J. Roth, R.M. Leithauser, J. Scherhag, R. Beneke, and H.A. Katus New highly sensitivity assay used to measure cardiac troponin T concentration changes during a continuous 216-km marathon Clin Chem 55 2009 590 592
52. E. Serrano-Ostariz, A. Legaz-Arrese, and J.L. Terreros-Blanco Cardiac biomarkers and exercise duration and intensity during a cycle-touring event Clin J Sport Med 19 2009 293 299
53. A. La Gerche, K.A. Connelly, D.J. Mooney, A.I. MacIsaac, and D.L. Prior Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise Heart 94 2008 860 866
54. R. Shave, E. Dawson, G. Whyte, K. George, D. Gaze, and P. Collinson Altered cardiac function and minimal cardiac damage during prolonged exercise Med Sci Sports Exerc 36 2004 1098 1103 (Pubitemid 38878981)
55. F. Fu, J. Nie, and T.K. Tong Serum cardiac troponin T in adolescent runners: effects of exercise intensity and duration Int J Sports Med 30 2009 168 172
56. T.G. Neilan, T.T. Ton-Nu, and D.S. Jassal Myocardial adaptation to short-term high-intensity exercise in highly trained athletes J Am Soc Echocardiogr 19 2006 1280 1285
57. A. Urhausen, J. Scharhag, M. Herrmann, and W. Kindermann Clinical significance of increased cardiac troponins T and I in participants of ultra-endurance events Am J Cardiol 94 2004 696 698
58. J. Scharhag, A. Urhausen, and G. Schneider Reproducibility and clinical significance of exercise-induced increases in cardiac troponins and N-terminal pro brain natriuretic peptide in endurance athletes Eur J Cardiovasc Prev Rehabil 13 2006 388 397
59. W.J. Rowe Extraordinary unremitting endurance exercise and permanent injury to normal heart Lancet 340 1992 712 714
60. S. Mohlenkamp, N. Lehmann, and F. Breuckmann Running: the risk of coronary events: prevalence and prognostic relevance of coronary atherosclerosis in marathon runners Eur Heart J 29 2008 1903 1910
61. P.L. McNeil, and R. Khakee Disruptions of muscle fiber plasma membranes Role in exercise-induced damage Am J Pathol 140 1992 1097 1109
62. A. Goette, A. Bukowska, and D. Dobrev Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles Eur Heart J 30 2009 1411 1420
63. E. Hultman, and K. Sahlin Acid-base balance during exercise Exerc Sport Sci Rev 8 1980 41 128
64. W.J. Evans, and J.G. Cannon The metabolic effects of exercise-induced muscle damage Exerc Sport Sci Rev 19 1991 99 125
65. M.S. Clarke, R.W. Caldwell, H. Chiao, K. Miyake, and P.L. McNeil Contraction-induced cell wounding and release of fibroblast growth factor in heart Circ Res 76 1995 927 934
66. A. Koller, and W. Schobersberger Post-exercise release of cardiac troponins J Am Coll Cardiol 53 2009 1341 author reply 13412
67. R.S. Ross, and T.K. Borg Integrins and the myocardium Circ Res 88 2001 1112 1119
68. M.H. Hessel, D.E. Atsma, E.J. van der Valk, W.H. Bax, M.J. Schalij, and A. van der Laarse Release of cardiac troponin I from viable cardiomyocytes is mediated by integrin stimulation Pflugers Arch 455 2008 979 986
69. L.H. Madsen, G. Christensen, and T. Lund Time course of degradation of cardiac troponin I in patients with acute ST-elevation myocardial infarction: the ASSENT-2 troponin substudy Circ Res 99 2006 1141 1147
70. R. Labugger, L. Organ, C. Collier, D. Atar, and J.E. Van Eyk Extensive troponin I and T modification detected in serum from patients with acute myocardial infarction Circulation 102 2000 1221 1226
71. J. Feng, B.J. Schaus, J.A. Fallavollita, T.C. Lee, and J.M. Canty Jr Preload induces troponin I degradation independently of myocardial ischemia Circulation 103 2001 2035 2037
72. M. Herrmann, J. Scharhag, M. Miclea, A. Urhausen, W. Herrmann, and W. Kindermann Post-race kinetics of cardiac troponin T and I and N-terminal pro-brain natriuretic peptide in marathon runners Clin Chem 49 2003 831 834