Key result
PEG precipitation identifies macrotroponin, preventing false myocarditis diagnosis and unnecessary activity restriction.
Why the study?
Macrotroponin complexes can cause falsely elevated troponin levels, complicating diagnosis and causing unnecessary exercise restriction in athletes presenting with clinical symptoms.
Case Report (n=1)
A discrepancy between elevated high-sensitivity troponin I and normal troponin T should raise suspicion for macrotroponin complexes, which can be confirmed via PEG precipitation to avoid unnecessary activity restrictions in athletes.
May prompt macrotroponin evaluation in athletes with troponin I-T discrepancy; case supports PEG testing but leaves open prospective validation.
Background Myocarditis can cause sudden cardiac death in athletes, and in the presence of clinical symptoms and elevated troponins, exercise restriction is recommended. However, macrotroponin complexes, formed by antitroponin antibodies, can cause falsely elevated troponin levels, thereby complicating the diagnostic process and leading to unnecessary exercise restriction. Case summary A 27-year-old professional cyclist presented with exercise intolerance following a viral illness. High-sensitivity troponin I was markedly elevated, while high-sensitivity troponin T remained normal. Major cardiac causes were excluded, raising suspicion for macrotroponin complexes. This was confirmed via polyethylene glycol (PEG) precipitation. The patient was cleared to return his sport activities without the need for further monitoring. Discussion In athletes, exercise-induced troponin release is common and may contribute to a higher prevalence of macrotroponin formation, which is an underrecognized cause of elevated troponin levels. A discrepancy between troponin I and T assay results can suggest its presence, which can be confirmed using polyethylene glycol precipitation, a simple method that helps avoid unnecessary testing, activity restrictions, and prolonged monitoring.
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Popelier et al. (2026) conducted a case report in Falsely elevated troponin I / Macrotroponinaemia (n=1). Polyethylene glycol (PEG) precipitation was evaluated on Confirmation of macrotroponin complexes. Polyethylene glycol precipitation confirmed the presence of macrotroponin complexes as the cause of falsely elevated troponin I, avoiding misdiagnosis of myocarditis and unnecessary exercise restriction.
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