Cardiac troponins and physical exercise. It's time to make a point
Giuseppe Lippi1, Gianfranco Cervellin, Giuseppe Banfi
1U.O. Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Italy. glippi@ao.pr.it
Biochemia Medica
|December 7, 2011
Summary
Highly sensitive troponin assays improve diagnosis of acute coronary syndrome (ACS) but can lower specificity. Exercise can cause measurable troponin increases in athletes, requiring careful clinical evaluation to avoid misdiagnosis of myocardial infarction (MI).
Area of Science:
- Cardiology
- Clinical Chemistry
- Sports Medicine
Background:
- Diagnosing acute coronary syndrome (ACS), especially myocardial infarction (MI), remains a significant medical challenge.
- Cardiospecific troponin assays revolutionized ACS diagnosis, with highly sensitive (HS) assays enhancing negative predictive value.
- HS troponin assays have reduced clinical specificity, leading to measurable troponin levels in various non-ACS conditions.
Purpose of the Study:
- To address the diagnostic challenges posed by HS troponin assays in the context of exercise.
- To differentiate exercise-induced troponin release from actual myocardial injury.
- To emphasize the need for comprehensive clinical assessment to prevent misdiagnosis of ACS/MI.
Main Methods:
- Review of clinical studies investigating HS troponin levels in athletes.
- Analysis of the implications of exercise-related troponin increases.
- Emphasis on integrated diagnostic approaches including serial biomarker measurements, clinical history, ECG, and imaging.
Main Results:
- Measurable increases in HS-troponins are observed in up to 94% of endurance athletes.
- Exercise-related troponin release is attributed to increased membrane permeability, not myocardial injury.
- HS troponin assays can lead to misinterpretation without careful clinical correlation.
Conclusions:
- Exercise-induced troponin release is a common finding with HS assays and does not indicate acute myocardial infarction.
- Accurate diagnosis of ACS/MI requires integrating HS troponin results with clinical context, serial testing, and other diagnostic tools.
- Careful clinical evaluation is crucial to prevent misdiagnosis of ACS/MI in athletes and healthy individuals.
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