The relationship between workload and exercise-induced cardiac troponin elevations is influenced by non-obstructive
Magnus Bjorkavoll-Bergseth1,2, Christine Erevik1, Øyunn Kleiven1
1Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Insights
Exercise-induced cardiac Troponin I (cTnI) elevation is linked to workload in athletes with non-obstructive coronary artery disease (CAD). This suggests CAD impacts cTnI response even without significant artery blockage.
Area of Science:
- Cardiology
- Sports Medicine
- Exercise Physiology
Background:
- Exercise can cause troponin elevation, but its relationship with non-obstructive coronary artery disease (CAD) is not well understood.
- Assessing troponin levels in athletes is crucial for differentiating exercise-induced changes from potential cardiac events.
- Non-obstructive CAD may influence myocardial response to high-intensity exercise.
Purpose of the Study:
- To investigate the impact of non-obstructive CAD on exercise-induced cardiac Troponin I (cTnI) elevation in middle-aged recreational athletes.
- To determine if the presence of non-obstructive CAD alters the correlation between exercise workload and cTnI response.
- To explore the relationship between exercise intensity, duration, and cTnI levels in athletes with and without atherosclerosis.
Main Methods:
- Observational study involving 40 well-trained recreational athletes (50 ± 9 years).
- High-sensitive cardiac Troponin I (cTnI) assay used to measure levels 24h before, and 3h and 24h after two high-intensity exercises: cardiopulmonary exercise test (CPET) and a 91-km mountain bike race.
- Coronary computed tomography angiography (CCTA) used to identify non-obstructive CAD (<50% obstruction).
Main Results:
- Post-exercise cTnI levels were significantly higher after the mountain bike race compared to CPET at both 3h and 24h.
- Absolute cTnI values did not differ between athletes with non-obstructive CAD (n=15) and those without (n=25).
- A significantly stronger positive correlation between cTnI response and exercise workload was observed in the non-obstructive CAD group compared to the normal group at both 3h and 24h post-exercise.
Conclusions:
- Exercise-induced cTnI elevation shows a strong correlation with exercise workload in middle-aged athletes with non-obstructive CAD.
- The presence of non-obstructive CAD appears to influence the relationship between exercise workload and cTnI response, even without significant coronary artery obstruction.
- These findings highlight the importance of considering underlying CAD in the interpretation of exercise-induced troponin elevations in athletes.
Abstract:
The relationship between exercise-induced troponin elevation and non-obstructive coronary artery disease (CAD) is unclear. This observational study assessed non-obstructive CAD's impact on exercise-induced cardiac Troponin I (cTnI) elevation in middle-aged recreational athletes. cTnI levels of 40 well-trained recreational athletes (73% males, 50 ± 9 years old) were assessed by a high-sensitive cTnI assay 24 h before, and at 3 and 24 h following two high-intensity exercises of different durations; a cardiopulmonary exercise test (CPET), and a 91-km mountain bike race. Workload was measured with power meters. Coronary computed tomography angiography was used to determine the presence or absence of non-obstructive (<50% obstruction) CAD. A total of 15 individuals had non-obstructive CAD (Atherosclerotic group), whereas 25 had no atherosclerosis (normal). There were higher post-exercise cTnI levels following the race compared with CPET, both at 3 h (77.0 (35.3-112.4) ng/L vs. 11.6 (6.4-22.5) ng/L, p < 0.001) and at 24 h (14.7 (6.7-16.3) vs. 5.0 (2.6-8.9) ng/L, p < 0.001). Absolute cTnI values did not differ among groups. Still, the association of cTnI response to power output was significantly stronger in the CAD versus Normal group both at 3 h post-exercise (Rho = 0.80, p < 0.001 vs. Rho = -0.20, p = 0.33) and 24-h post-exercise (Rho = 0.87, p < 0.001 vs. Rho = -0.13, p = 0.55). Exercise-induced cTnI elevation was strongly correlated with exercise workload in middle-aged athletes with non-obstructive CAD but not in individuals without CAD. This finding suggests that CAD influences the relationship between exercise workload and the cTnI response even without coronary artery obstruction.
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