Key result
High postexercise troponin shows no association with greater occult coronary atherosclerosis in recreational athletes.
Why the study?
Exercise increases cardiac troponin concentrations with significant heterogeneity across individuals, but its relationship with occult coronary atherosclerosis remained unclear.
Does high postexercise cardiac troponin concentration indicate occult coronary atherosclerosis in middle-aged recreational athletes?
Cohort (n=102)
Does high postexercise cardiac troponin concentration indicate occult coronary atherosclerosis in middle-aged recreational athletes?
Odds Ratio: 1.55 (95% CI 0.81–2.93)
Absolute Event Rate: 67.6% vs 50%
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Postexercise troponin bumps often exceed conventional upper-limit-of-normal/acute MI cut points but have no relationship with clinical acute coronary syndromes. While it has been interesting to study this phenomenon, the actionable clinical message is simple. Do not check a troponin level in an athlete after exercise unless there is a clear clinical picture of an acute coronary syndrome.”
“It's a neutral study. There was no difference between the high and low [cTn] responders. It means that if you compete in an exercise event, and it happens that you have very high postexercise troponin, it's unlikely attributable to underlying coronary disease.”
“We don't know what causes it, and some people have postulated that it's really a marker of subclinical atherosclerosis. If someone runs a marathon and they have a rise in troponin, it might mean their coronary arteries aren't so good. This study is useful because it says that's not true. There was no correlation between the extent of atherosclerosis and the extent of [troponin] elevation. It's checking one box as to what might be the cause of it.”
The magnitude of exercise-induced cardiac troponin elevations in middle-aged recreational athletes is not primarily attributable to occult coronary atherosclerosis.
BACKGROUND Exercise increases cardiac troponin (cTn) concentrations with significant heterogeneity across individuals. OBJECTIVES This study compared the prevalence and magnitude of coronary atherosclerosis in middle-aged recreational athletes with high vs low postexercise cTn concentrations. METHODS Pre- and postexercise concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and hs-cTnI were assessed among 1,011 long-distance walkers, cyclists, and runners (median age 56 years [Q1-Q3: 49-62 years], 63% male). Subsequently, 68 high cTn responders (hs-cTnT: 35.4 ng/L [Q1-Q3: 20.2-54.0 ng/L]; hs-cTnI: 47.4 ng/L [Q1-Q3: 22.5-97.4 ng/L]) and 34 low responders (hs-cTnT: 8.5 ng/L [Q1-Q3: 5.4-13.3 ng/L]; hs-cTnI: 2.5 ng/L [Q1-Q3: 1.5-5.8 ng/L]), matched for age, sex, and sport type, underwent a cardiac computed tomography (CT) scan to determine the presence and characteristics of coronary atherosclerosis (Coronary Artery Disease-Reporting and Data System [CAD-RADS] 2.0 score and coronary artery calcium scores). CT-derived fractional flow reserve (CT-FFR) analyses assessed the hemodynamic relevance of stenoses ≥25% to 90%. RESULTS The prevalence (CAD-RADS >0 in 67.6% vs 50.0%; ORadjusted: 1.55 [95% CI: 0.81-2.93]) and magnitude (coronary artery calcium score: 9 AU [Q1-Q3: 0-111 AU] vs 2 AU [Q1-Q3: 0-145 AU]; P = 0.58) of coronary atherosclerosis did not differ between high and low cTn responders. CT-FFR outcomes (FFR ≤0.75: 11.8% vs 5.9%; ORadjusted: 1.03 [Q1-Q3: 0.67-1.60]) also revealed no differences between high and low cTn responders. Nevertheless, weak associations (P < 0.05; R2: 4%-8%) were found between hs-cTnT, hs-cTnI concentrations, and CAD-RADS classifications. CONCLUSIONS The prevalence and magnitude of coronary atherosclerosis did not differ between recreational athletes with high vs low postexercise cTn concentrations. This suggests that most of the interindividual variation in exercise-induced cTn elevations is not attributable to occult coronary atherosclerosis.
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Janssen et al. (2025) conducted a cohort in Occult coronary atherosclerosis (n=102). High postexercise cardiac troponin concentration vs. Low postexercise cardiac troponin concentration was evaluated on Prevalence of coronary atherosclerosis (CAD-RADS >0) (OR 1.55, 95% CI 0.81-2.93). High postexercise cardiac troponin concentrations were not associated with a significantly higher prevalence of occult coronary atherosclerosis compared to low concentrations in middle-aged recreational athletes (67.6% vs 50.0%; adjusted OR 1.55).
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