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. 2021 Mar 26:12:651851.
doi: 10.3389/fphys.2021.651851. eCollection 2021.

Kinetics, Moderators and Reference Limits of Exercise-Induced Elevation of Cardiac Troponin T in Athletes: A Systematic Review and Meta-Analysis

Feifei Li  1   2 , Will G Hopkins  3 , Xuejing Wang  4 , Julien S Baker  1   2 , Jinlei Nie  5 , Junqiang Qiu  6 , Binh Quach  1 , Kun Wang  7 , Longyan Yi  8
Affiliations

Kinetics, Moderators and Reference Limits of Exercise-Induced Elevation of Cardiac Troponin T in Athletes: A Systematic Review and Meta-Analysis

Feifei Li et al. Front Physiol. .

Abstract

Background: Kinetics, moderators and reference limits for exercise-induced cardiac troponin T (cTnT) elevations are still unclear. Methods: A systematic review of published literature was conducted adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies reporting high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after a bout of exercise in athletes were included and analyzed. The final dataset consisted of 62 estimates from 16 bouts in 13 studies of 5-1,002 athletes (1,421 in total). Meta-analysis was performed using general linear mixed modeling and Bayesian inferences about effect magnitudes. Modifying fixed-effect moderators of gender, age, baseline level, exercise duration, intensity and modalities were investigated. Simulation was used to derive 99th percentile with 95% limits of upper reference ranges for hs-cTnT of athletic populations. Results: The mean and upper reference limits of hs-cTnT before exercise were 4.4 and 19 ng.L-1. Clear increases in hs-cTnT ranging from large to very large (factor changes of 2.1-7.5, 90% compatibility limits, ×/÷1.3) were evident from 0.7 through 25 h, peaking at 2.9 h after the midpoint of a 2.5-h bout of running, when the mean and upper reference limit for hs-cTnT were 33 and 390 ng L-1. A four-fold increase in exercise duration produced a large clear increase (2.4, ×/÷1.7) in post-exercise hs-cTnT. Rowing exercise demonstrated an extremely large clear reduction (0.1 ×/÷2.4). Conclusions: The kinetics of cTnT elevation following exercise, the positive effect of exercise duration, the impact of exercise modality and 99th upper reference limits for athletic populations were reasonably well defined by this meta-analysis.

Keywords: cardiac biomarker; cycling; marathon; reference range; running; swimming; time-course; triathlon.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart outlining literature search, inclusion and exclusion of studies.
Figure 2
Figure 2
Individual study-estimate and meta-analyzed predicted mean serum concentrations of high-sensitivity cardiac troponin T (hs-cTnT), plotted against the mean adjusted post-exercise time (post-exercise time plus half the duration of exercise). The meta-analyzed pre-exercise mean is for the average male athlete. The meta-analyzed post-exercise means are for the average male running for 2.5 h with a mean heart rate of 155 min−1 and a pre-exercise hs-cTnT of 4.4 ng L−1. Bars are 90% compatibility intervals.
Figure 3
Figure 3
Individual study-estimate and meta-analyzed predicted factor standard deviations (SD) of serum concentration of high-sensitivity cardiac troponin T (hs-cTnT) for athletes and exercise shown in Figure 2 Bars are 90% compatibility intervals.
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References

    1. Aagaard P., Sahlen A., Bergfeldt L., Braunschweig F. (2014). Heart rate and its variability in response to running-associations with troponin. Med. Sci. Sports Exerc. 46, 1624–1630. 10.1249/MSS.0000000000000270 - DOI - PubMed
    1. Aakre K. M., Kleiven O., Skadberg O., Bjorkavoll-Bergseth M. F., Melberg T., Strand H., et al. . (2018). The copeptin response after physical activity is not associated with cardiac biomarkers or asymptomatic coronary artery disease: The North Sea Race Endurance Exercise Study (NEEDED) 2013. Clin. Biochem. 52, 8–12. 10.1016/j.clinbiochem.2017.10.007 - DOI - PubMed
    1. Aakre K. M., Saeed N., Wu A. H. B., Kavsak P. A. (2020). Analytical performance of cardiac troponin assays - Current status and future needs. Clin. Chim. Acta 509, 149–155. 10.1016/j.cca.2020.06.021 - DOI - PubMed
    1. Apple F. S., Jaffe A. S., Collinson P., Mockel M., Ordonez-Llanos J., Lindahl B., et al. . (2015). IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin. Biochem. 48, 201–203. 10.1016/j.clinbiochem.2014.08.021 - DOI - PubMed
    1. Baker P., Leckie T., Harrington D., Richardson A. (2019). Exercise-induced cardiac troponin elevation: an update on the evidence, mechanism and implications. Int. J. Cardiol. Heart. Vasc. 22, 181–186. 10.1016/j.ijcha.2019.03.001 - DOI - PMC - PubMed

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