Skip to main content
Top
Published in: Clinical Research in Cardiology 6/2010

01-06-2010 | Original Paper

Cardiac troponin T elevations, using highly sensitive assay, in recreational running depend on running distance

Authors: Alma M. A. Mingels, Leo H. J. Jacobs, Vincent W. Kleijnen, Eduard M. Laufer, Bjorn Winkens, Leonard Hofstra, Will K. W. H. Wodzig, Marja P. van Dieijen-Visser

Published in: Clinical Research in Cardiology | Issue 6/2010

Login to get access

Abstract

Background

Endurance exercise is frequently associated with cardiac troponin (cTn) concentrations, otherwise corresponding to minor myocardial infarction. However, research on the underlying mechanisms has been limited because of assay restraints in the low concentration range.

Methods and results

Using the pre-commercial, highly sensitive hs-cTnT assay, cTnT concentrations were measured in samples from recreational runners obtained before and after running 5 km (trained, n = 43/untrained, n = 122), 15 km (n = 38), 21 km (n = 10), and 42 km (n = 85) (all trained). The percentage of runners with elevated cTnT concentrations after the run increased with running distance (0, 11, 13, 40, and 86%), in contrast to NT-proBNP (2, 7, 0, 0, 5). Median (IQR) cTnT post-run concentrations were 0.004 μg/L (0.003), 0.006 μg/L (0.008), 0.010 μg/L (0.006), 0.014 μg/L (0.019), and 0.030 μg/L (0.029), respectively.

Conclusions

We found, using a novel hs-cTnT assay, the distance of recreational competitive running to be positively related to asymptomatic increases in cTnT post-run concentrations. In contrast, NT-proBNP showed no increase. In addition, the data indicated that a relatively short running distance of 5 km resulted in cTnT release of untrained participants, in contrast to trained participants, which underlines the necessity of sufficient training. Further effort is needed to clarify the significance of exercise-induced cardiac biomarker elevations.
Literature
1.
go back to reference Apple FS, Wu AH, Jaffe AS, Panteghini M, Christenson RH, Cannon CP, Francis G, Jesse RL, Morrow DA, Newby LK, Storrow AB, Tang WH, Pagani F, Tate J, Ordonez-Llanos J, Mair J (2007) National Academy of Clinical Biochemistry and IFCC Committee for standardization of markers of cardiac damage laboratory medicine practice guidelines: analytical issues for biomarkers of heart failure. Circulation 116:e95–e98CrossRefPubMed Apple FS, Wu AH, Jaffe AS, Panteghini M, Christenson RH, Cannon CP, Francis G, Jesse RL, Morrow DA, Newby LK, Storrow AB, Tang WH, Pagani F, Tate J, Ordonez-Llanos J, Mair J (2007) National Academy of Clinical Biochemistry and IFCC Committee for standardization of markers of cardiac damage laboratory medicine practice guidelines: analytical issues for biomarkers of heart failure. Circulation 116:e95–e98CrossRefPubMed
2.
go back to reference Apple FS, Jesse RL, Newby LK, Wu AH, Christenson RH, Cannon CP, Francis G, Morrow DA, Ravkilde J, Storrow AB, Tang W, Jaffe AS, Mair J, Ordonez-Llanos J, Pagani F, Panteghini M, Tate J (2007) National Academy of Clinical Biochemistry and IFCC Committee for standardization of markers of cardiac damage laboratory medicine practice guidelines: analytical issues for biochemical markers of acute coronary syndromes. Clin Chem 53:547–551CrossRefPubMed Apple FS, Jesse RL, Newby LK, Wu AH, Christenson RH, Cannon CP, Francis G, Morrow DA, Ravkilde J, Storrow AB, Tang W, Jaffe AS, Mair J, Ordonez-Llanos J, Pagani F, Panteghini M, Tate J (2007) National Academy of Clinical Biochemistry and IFCC Committee for standardization of markers of cardiac damage laboratory medicine practice guidelines: analytical issues for biochemical markers of acute coronary syndromes. Clin Chem 53:547–551CrossRefPubMed
3.
go back to reference Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G (2005) Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26:516–524CrossRefPubMed Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G (2005) Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26:516–524CrossRefPubMed
4.
go back to reference Fortescue EB, Shin AY, Greenes DS, Mannix RC, Agarwal S, Feldman BJ, Shah MI, Rifai N, Landzberg MJ, Newburger JW, Almond CS (2007) Cardiac troponin increases among runners in the Boston Marathon. Ann Emerg Med 49:137–143, 143.e1CrossRefPubMed Fortescue EB, Shin AY, Greenes DS, Mannix RC, Agarwal S, Feldman BJ, Shah MI, Rifai N, Landzberg MJ, Newburger JW, Almond CS (2007) Cardiac troponin increases among runners in the Boston Marathon. Ann Emerg Med 49:137–143, 143.e1CrossRefPubMed
5.
go back to reference Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA (2010) Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 56:254–261CrossRefPubMed Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA (2010) Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 56:254–261CrossRefPubMed
6.
go back to reference Gustafsson F, Steensgaard-Hansen F, Badskjaer J, Poulsen AH, Corell P, Hildebrandt P (2005) Diagnostic and prognostic performance of N-terminal ProBNP in primary care patients with suspected heart failure. J Card Fail 11:S15–S20CrossRefPubMed Gustafsson F, Steensgaard-Hansen F, Badskjaer J, Poulsen AH, Corell P, Hildebrandt P (2005) Diagnostic and prognostic performance of N-terminal ProBNP in primary care patients with suspected heart failure. J Card Fail 11:S15–S20CrossRefPubMed
7.
go back to reference Hessel MH, Atsma DE, van der Valk EJ, Bax WH, Schalij MJ, van der Laarse A (2008) Release of cardiac troponin I from viable cardiomyocytes is mediated by integrin stimulation. Pflugers Arch 455:979–986CrossRefPubMed Hessel MH, Atsma DE, van der Valk EJ, Bax WH, Schalij MJ, van der Laarse A (2008) Release of cardiac troponin I from viable cardiomyocytes is mediated by integrin stimulation. Pflugers Arch 455:979–986CrossRefPubMed
8.
go back to reference Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, Pinto YM, Richards M (2006) NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J 27:330–337CrossRefPubMed Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, Pinto YM, Richards M (2006) NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J 27:330–337CrossRefPubMed
9.
go back to reference Jassal DS, Moffat D, Krahn J, Ahmadie R, Fang T, Eschun G, Sharma S (2009) Cardiac injury markers in non-elite marathon runners. Int J Sports Med 30:75–79CrossRefPubMed Jassal DS, Moffat D, Krahn J, Ahmadie R, Fang T, Eschun G, Sharma S (2009) Cardiac injury markers in non-elite marathon runners. Int J Sports Med 30:75–79CrossRefPubMed
10.
go back to reference Kavsak PA, MacRae AR, Yerna MJ, Jaffe AS (2009) Analytic and clinical utility of a next-generation, highly sensitive cardiac troponin I assay for early detection of myocardial injury. Clin Chem 55:573–577CrossRefPubMed Kavsak PA, MacRae AR, Yerna MJ, Jaffe AS (2009) Analytic and clinical utility of a next-generation, highly sensitive cardiac troponin I assay for early detection of myocardial injury. Clin Chem 55:573–577CrossRefPubMed
11.
go back to reference Lippi G, Schena F, Salvagno GL, Montagnana M, Gelati M, Tarperi C, Banfi G, Guidi GC (2008) Influence of a half-marathon run on NT-proBNP and troponin T. Clin Lab 54:251–254PubMed Lippi G, Schena F, Salvagno GL, Montagnana M, Gelati M, Tarperi C, Banfi G, Guidi GC (2008) Influence of a half-marathon run on NT-proBNP and troponin T. Clin Lab 54:251–254PubMed
12.
go back to reference Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM Jr, Krauss MD, Maron MS, Mitten MJ, Roberts WO, Puffer JC (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 115:1643–1655 Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM Jr, Krauss MD, Maron MS, Mitten MJ, Roberts WO, Puffer JC (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 115:1643–1655
13.
go back to reference Michielsen EC, Wodzig WK, Van Dieijen-Visser MP (2008) Cardiac troponin T release after prolonged strenuous exercise—a review. Sports Med 38:425–435CrossRefPubMed Michielsen EC, Wodzig WK, Van Dieijen-Visser MP (2008) Cardiac troponin T release after prolonged strenuous exercise—a review. Sports Med 38:425–435CrossRefPubMed
14.
go back to reference Middleton N, George K, Whyte G, Gaze D, Collinson P, Shave R (2008) Cardiac troponin T release is stimulated by endurance exercise in healthy humans. J Am Coll Cardiol 52:1813–1814CrossRefPubMed Middleton N, George K, Whyte G, Gaze D, Collinson P, Shave R (2008) Cardiac troponin T release is stimulated by endurance exercise in healthy humans. J Am Coll Cardiol 52:1813–1814CrossRefPubMed
15.
go back to reference Mingels A, Jacobs L, Michielsen E, Swaanenburg J, Wodzig W, van Dieijen-Visser M (2009) Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays. Clin Chem 55:101–108CrossRefPubMed Mingels A, Jacobs L, Michielsen E, Swaanenburg J, Wodzig W, van Dieijen-Visser M (2009) Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays. Clin Chem 55:101–108CrossRefPubMed
16.
go back to reference Neilan TG, Yoerger DM, Douglas PS, Marshall JE, Halpern EF, Lawlor D, Picard MH, Wood MJ (2006) Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J 27:1079–1084CrossRefPubMed Neilan TG, Yoerger DM, Douglas PS, Marshall JE, Halpern EF, Lawlor D, Picard MH, Wood MJ (2006) Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J 27:1079–1084CrossRefPubMed
17.
go back to reference Neilan TG, Januzzi JL, Lee-Lewandrowski E, Ton-Nu TT, Yoerger DM, Jassal DS, Lewandrowski KB, Siegel AJ, Marshall JE, Douglas PS, Lawlor D, Picard MH, Wood MJ (2006) Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation 114:2325–2333CrossRefPubMed Neilan TG, Januzzi JL, Lee-Lewandrowski E, Ton-Nu TT, Yoerger DM, Jassal DS, Lewandrowski KB, Siegel AJ, Marshall JE, Douglas PS, Lawlor D, Picard MH, Wood MJ (2006) Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation 114:2325–2333CrossRefPubMed
18.
go back to reference Panteghini M, Pagani F, Yeo KT, Apple FS, Christenson RH, Dati F, Mair J, Ravkilde J, Wu AH (2004) Evaluation of imprecision for cardiac troponin assays at low-range concentrations. Clin Chem 50:327–332CrossRefPubMed Panteghini M, Pagani F, Yeo KT, Apple FS, Christenson RH, Dati F, Mair J, Ravkilde J, Wu AH (2004) Evaluation of imprecision for cardiac troponin assays at low-range concentrations. Clin Chem 50:327–332CrossRefPubMed
19.
go back to reference Sabatine MS, Morrow DA, de Lemos JA, Jarolim P, Braunwald E (2009) Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: results from TIMI 35. Eur Heart J 30:162–169CrossRefPubMed Sabatine MS, Morrow DA, de Lemos JA, Jarolim P, Braunwald E (2009) Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: results from TIMI 35. Eur Heart J 30:162–169CrossRefPubMed
20.
go back to reference Scharhag J, George K, Shave R, Urhausen A, Kindermann W (2008) Exercise-associated increases in cardiac biomarkers. Med Sci Sports Exerc 40:1408–1415CrossRefPubMed Scharhag J, George K, Shave R, Urhausen A, Kindermann W (2008) Exercise-associated increases in cardiac biomarkers. Med Sci Sports Exerc 40:1408–1415CrossRefPubMed
21.
go back to reference Scharhag J, Shave R, George K, Whyte G, Kindermann W (2008) Exercise-induced increases in cardiac troponins in endurance athletes: a matter of exercise duration and intensity? Clin Res Cardiol 97:62–63 author reply 61CrossRefPubMed Scharhag J, Shave R, George K, Whyte G, Kindermann W (2008) Exercise-induced increases in cardiac troponins in endurance athletes: a matter of exercise duration and intensity? Clin Res Cardiol 97:62–63 author reply 61CrossRefPubMed
22.
go back to reference Scharhag J, Herrmann M, Urhausen A, Haschke M, Herrmann W, Kindermann W (2005) Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise. Am Heart J 150:1128–1134CrossRefPubMed Scharhag J, Herrmann M, Urhausen A, Haschke M, Herrmann W, Kindermann W (2005) Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise. Am Heart J 150:1128–1134CrossRefPubMed
23.
go back to reference Serrano-Ostariz E, Legaz-Arrese A, Terreros-Blanco JL, Lopez-Ramon M, Cremades-Arroyos D, Carranza-Garcia LE, Izquierdo-Alvarez S, Bocos-Terraz P (2009) Cardiac biomarkers and exercise duration and intensity during a cycle-touring event. Clin J Sport Med 19:293–299CrossRefPubMed Serrano-Ostariz E, Legaz-Arrese A, Terreros-Blanco JL, Lopez-Ramon M, Cremades-Arroyos D, Carranza-Garcia LE, Izquierdo-Alvarez S, Bocos-Terraz P (2009) Cardiac biomarkers and exercise duration and intensity during a cycle-touring event. Clin J Sport Med 19:293–299CrossRefPubMed
24.
go back to reference Shave R, George K, Gaze D (2007) The influence of exercise upon cardiac biomarkers: a practical guide for clinicians and scientists. Curr Med Chem 14:1427–1436CrossRefPubMed Shave R, George K, Gaze D (2007) The influence of exercise upon cardiac biomarkers: a practical guide for clinicians and scientists. Curr Med Chem 14:1427–1436CrossRefPubMed
25.
go back to reference Shave R, George KP, Atkinson G, Hart E, Middleton N, Whyte G, Gaze D, Collinson PO (2007) Exercise-induced cardiac troponin T release: a meta-analysis. Med Sci Sports Exerc 39:2099–2106CrossRefPubMed Shave R, George KP, Atkinson G, Hart E, Middleton N, Whyte G, Gaze D, Collinson PO (2007) Exercise-induced cardiac troponin T release: a meta-analysis. Med Sci Sports Exerc 39:2099–2106CrossRefPubMed
26.
go back to reference Siegel AJ, Januzzi J, Sluss P, Lee-Lewandrowski E, Wood M, Shirey T, Lewandrowski KB (2008) Cardiac biomarkers, electrolytes, and other analytes in collapsed marathon runners: implications for the evaluation of runners following competition. Am J Clin Pathol 129:948–951CrossRefPubMed Siegel AJ, Januzzi J, Sluss P, Lee-Lewandrowski E, Wood M, Shirey T, Lewandrowski KB (2008) Cardiac biomarkers, electrolytes, and other analytes in collapsed marathon runners: implications for the evaluation of runners following competition. Am J Clin Pathol 129:948–951CrossRefPubMed
27.
go back to reference Tate JR, Ferguson W, Bais R, Kostner K, Marwick T, Carter A (2008) The determination of the 99th centile level for troponin assays in an Australian reference population. Ann Clin Biochem 45:275–288CrossRefPubMed Tate JR, Ferguson W, Bais R, Kostner K, Marwick T, Carter A (2008) The determination of the 99th centile level for troponin assays in an Australian reference population. Ann Clin Biochem 45:275–288CrossRefPubMed
28.
29.
go back to reference Vidotto C, Tschan H, Atamaniuk J, Pokan R, Bachl N, Muller MM (2005) Responses of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) to competitive endurance exercise in recreational athletes. Int J Sports Med 26:645–650CrossRefPubMed Vidotto C, Tschan H, Atamaniuk J, Pokan R, Bachl N, Muller MM (2005) Responses of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) to competitive endurance exercise in recreational athletes. Int J Sports Med 26:645–650CrossRefPubMed
30.
go back to reference Weber M, Hamm C (2006) Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart 92:843–849CrossRefPubMed Weber M, Hamm C (2006) Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart 92:843–849CrossRefPubMed
Metadata
Title
Cardiac troponin T elevations, using highly sensitive assay, in recreational running depend on running distance
Authors
Alma M. A. Mingels
Leo H. J. Jacobs
Vincent W. Kleijnen
Eduard M. Laufer
Bjorn Winkens
Leonard Hofstra
Will K. W. H. Wodzig
Marja P. van Dieijen-Visser
Publication date
01-06-2010
Publisher
Springer-Verlag
Published in
Clinical Research in Cardiology / Issue 6/2010
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-010-0134-x

Other articles of this Issue 6/2010

Clinical Research in Cardiology 6/2010 Go to the issue