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. 2025 Jun 24;85(24):2370-2382.
doi: 10.1016/j.jacc.2025.04.047.

Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes

Sylvan L J E Janssen  1 , Wouter M van Everdingen  2 , Wouter B J Saalmink  1 , Sacha K Lamers  3 , Wim H M Vroemen  4 , Ellen J S Denessen  3 , Kristian Berge  5 , Otto Bekers  3 , Maria T E Hopman  1 , Monique Brink  6 , Jesse Habets  7 , Vincent L Aengevaeren  8 , Alma M A Mingels  3 , Robin Nijveldt  9 , Thijs M H Eijsvogels  10 ; TREAT study collaboration  1
Collaborators, Affiliations

Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes

Sylvan L J E Janssen et al. J Am Coll Cardiol. .

Abstract

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.

Keywords: athletes; biomarkers; cardiovascular diseases; computed tomography; coronary artery disease; exercise; radiology.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Janssen has received grants from the Radboud University Medical Center the Academic Alliance Fund. Dr Vroemen has received grants from the Academic Alliance Fund. Dr Berge has received speaker honoraria from Boehringer Ingelheim. Dr Habets has received speaker honoraria from Boehringer Ingelheim and GE Healthcare. Dr Mingels has received grants from VENI (file number 09150161810155) from the Dutch Research Council (Nederlandse Organisatie voor Wetenschappelijk Onderzoek, NWO); and has received support from Abbott Diagnostics and Roche Diagnostics. Dr Eijsvogels has received grants from an Established Investigator E-Dekker grant (#03-002-2023-0036) and the FIT-HEART consortium grant (#01-001-2024-0621) of the Dutch Heart Foundation. Dr Nijveldt has received unrestricted research grants from Philips Volcano and Biotronik; and has received speaker fees from BMS, Pfizer, and Sanofi Genzyme. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.