Kinetics, Moderators and Reference Limits of Exercise-Induced Elevation of Cardiac Troponin T in Athletes: A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of non-randomized observational and pre-post cohort studies
PubMed 33841187 · doi:10.3389/fphys.2021.651851
What was done
A systematic review and meta-analysis adhering to PRISMA guidelines evaluated high-sensitivity cardiac troponin T (hs-cTnT) kinetics, moderators, and reference limits before and after acute exercise in athletes. The authors synthesized 62 estimates from 16 exercise bouts across 13 studies comprising 1,421 athletes (study sample sizes ranged from 5 to 1,002). Meta-analysis utilized general linear mixed modeling and Bayesian inferences to assess the impact of sex, age, baseline values, exercise duration, intensity, and modality, followed by simulation to calculate 99th percentile upper reference limits.
What was found
Baseline pre-exercise hs-cTnT had a mean of 4.4 ng/L and an upper reference limit of 19 ng/L. Concentrations increased substantially between 0.7 and 25 hours post-exercise (factor changes 2.1 to 7.5; 90% compatibility limits, ×/÷1.3), peaking at 2.9 hours after the midpoint of a 2.5-hour running bout. At peak, the mean was 33 ng/L and the upper reference limit reached 390 ng/L. A 4-fold increase in exercise duration led to a 2.4-fold increase (×/÷1.7) in post-exercise hs-cTnT, while rowing was associated with a marked reduction (factor change 0.1, ×/÷2.4) compared to running.
Why it matters
These findings establish post-exercise kinetic timelines and upper reference thresholds for hs-cTnT in endurance athletes. This helps clinicians distinguish physiological troponin elevations after strenuous exercise from acute myocardial infarction in emergency settings.
Limits
The analysis is restricted to 13 studies with wide variations in sample sizes (5 to 1,002 participants). Non-running modalities had limited data, and the abstract provides no information on whether underlying subclinical cardiovascular disease was systematically ruled out across cohorts.
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