Cardiac troponin release in athletes: what do we know and where should we go?

Cardiac troponins (cTn) are proteins that regulate cardiomyocyte contraction. A rise and fall of cTn above the upper reference limit is diagnostic of myocardial injury. Therefore, cTn measurements are part of the routine workup when suspecting acute coronary syndromes. Exercise can also produce cTn elevations. Many studies in the last three decades have advanced our understanding of exercise-induced cTn release. Beyond technical improvements in cTn assays, various predictors of cTn release have been identified, whereas insight into exercise-induced cTn release patterns and its clinical implications have been improved. Whether cTn release in athletes represents a physiological or pathological response remains a topic of debate. This review summarizes our current understanding of exercise-induced cTn release and provides directions for future studies. We address how to 1) discriminate physiological versus pathological cTn release, 2) unravel the underlying mechanisms of exercise-induced cTn release, and 3) determine whether exercise-induced cTn elevation is a novel cardiovascular risk factor.