Kinetics of highly sensitive troponin I and T after eccentric exercise

exercise; myocardial injury; sport; troponin.Measurement of cardiac troponins is currently acknowledgedas the diagnostic gold standard for assessing cardiac injuryand diagnosing acute myocardial infarction (1). Althoughendurance exercise produces a kaleidoscope of cardiovas-cular benefits, several studies have reported significantincreases in cardiac troponins following strenuous and pro-longed physical exercise, especially following marathon run-ning (2, 3). This specific phenomenon, which has also beencalled ‘‘the runner’s syndrome’’, has been substantiallyamplified with the advent of the novel highly sensitive (HS)cardiac troponin assays; the percentage of sportsmen show-ing post-exercise values above the 99th percentile of theupper reference limit (URL) of the healthy population mightbe as high as 90% (4, 5). This increase is most likely phys-iological (e.g., reflecting transitory myocardial ischemia,development of blebs on the surface of cardiac myocytes,release of cytoplasmic contents of troponin without franknecrosis) (6), rather than being attributable to a more com-plex pathological phenomenon characterized by irreversiblecell injury and necrosis of cardiac myocytes, as demonstrated