Marathon running as a cause of troponin elevation: a systematic review and meta-analysis
Steven Regwan1, Edward A Hulten, Shaun Martinho
1Cardiology Service, San Antonio Military Medical Center, San Antonio, Texas, USA.
Insights
Cardiac troponin (cTn) levels frequently elevate in marathon runners post-race. This systematic review found a 51% incidence of elevated cTn, highlighting potential, yet unclear, cardiovascular implications.
Area of Science:
- Cardiology
- Sports Medicine
- Biomarkers
Background:
- Cardiac troponin (cTn) is a sensitive and specific marker for myocardial injury in acute coronary syndrome.
- Marathon running is a strenuous endurance event that may impact cardiac biomarkers.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of cardiac troponin elevations in marathon runners.
- To assess the odds of cTn elevation following marathon completion.
Main Methods:
- Systematic review and meta-analysis of observational studies published before September 2009.
- Included studies of marathon runners with serum cTn levels measured within 24 hours post-race.
- Calculated pooled odds ratio for cTn elevation and pooled prevalence.
Main Results:
- Sixteen studies with 939 participants were analyzed.
- The pooled incidence of post-marathon cTn elevation was 51% (95% CI 33-69%).
- The odds ratio for elevated cTn post-race was 51.84 (95% CI 16-168), with cTnI less commonly elevated than cTnT.
Conclusions:
- Cardiac troponin levels are frequently elevated in marathon runners after completing the race.
- The cardiovascular significance of these post-marathon cTn elevations remains unclear.
- Elevation appears consistent across diverse marathon runner populations.
Background:
Cardiac troponin (cTn) has high sensitivity and specificity for myocardial injury in acute coronary syndrome. Our objective was to review the published literature regarding the incidence of cTn elevations in marathon runners.
Methods:
Systematic review and meta-analysis of observational studies published before September 2009. We included studies of patients who had completed a marathon and had serum cTn levels within 24 hours. The primary outcome was the odds ratio for conversion of a normal pre-marathon cTn to an elevated post-marathon cTn. Secondary outcomes included the pooled prevalence of cTn elevation and comparison of the odds ratio for post-marathon elevation of cTnI versus cTnT.
Results:
Sixteen studies of 939 participants met criteria for inclusion. The mean age was 39 ± 4 years and patients were 74 ± 14% male. There were 6 pre-marathon cTn elevations and 579 post-race elevations. The pooled odds ratio for converting from a normal pre-race to an elevated post-race cTn was 51.84 (95% CI 16-168, I² = 66%, P < 0.001). The pooled incidence of a post-marathon cTn elevation was 51% (95% CI 33-69, I² = 98%, P < 0.001) of all runners. For the primary outcome there was no significant publication bias. Age and gender were not associated, but publication date and assay sensitivity was associated with cTn elevation. cTnI was less commonly elevated versus cTnT.
Conclusions:
The available data demonstrate that cTn levels are frequently elevated after a marathon with unclear cardiovascular significance. This elevation of cTn appears to be consistent among a diverse patient population.
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