Marathon running induced high-sensitivity cardiac troponin T elevation above the myocardial infarction threshold in 100% of participants at 0 and 3 hours post-race, falling to 22% at 24 hours.
How does serial cardiac troponin testing help differentiate exercise-induced troponin elevation from myocardial infarction in patients with post-exercise chest pain?
Understanding the distinct kinetics of exercise-induced cardiac troponin elevation helps clinicians differentiate benign physiological responses from acute myocardial infarction.
Post-exercise cardiac troponin (cTn) elevation is a recognised phenomenon which historically has been detected using standard sensitivity assays. More recently high-sensitivity assays have been developed and are now the gold standard for detection of cTn in the clinical setting. Although the assay's enhanced sensitivity confers benefits it has created new challenges for clinicians. By evaluating the change in cTn values over time, taking into account biological and analytical variation, the clinician is able to differentiate between a pathological and normal cTn value. As a result, serial cTn testing has become a fundamental component of the clinical assessment of chest pain patients and is included in the most recent definition for myocardial infarction and the latest guidelines for the management of acute coronary syndromes without persistent ST-segment elevation. A review of the cTn kinetics literature demonstrates a pattern of elevation and peak within the first 4 h after exercise dropping within 24 h. In contrast myocardial necrosis demonstrates a later cTn peak with a slower downslope occurring over several days. Understanding cTn kinetics facilitates clinician's decision making when presented with a chest pain patient post-exercise. Furthermore, it helps elucidate the underlying mechanism and establish the clinical significance of post-exercise cTn elevation, which in all other situations confers negative prognostic value. We recommend serial cTn testing in this scenario with a suggested algorithm included in this review.
Baker et al. (Fri,) conducted a review in Exercise-induced cardiac troponin elevation (n=26). Marathon running vs. Baseline (pre-race) was evaluated on High-sensitivity cardiac troponin T (HS-cTnT) elevation above the 99th percentile URL (14 ng/L). Marathon running induced high-sensitivity cardiac troponin T elevation above the myocardial infarction threshold in 100% of participants at 0 and 3 hours post-race, falling to 22% at 24 hours.