Raised troponin T and echocardiographic abnormalities after prolonged strenuous exercise—the Australian Ironman Triathlon
Louise Tulloh,Diana Robinson,Anushka Patel,Amanda Ware,Catherine Prendergast,David R. Sullivan,Lynne Pressley +6 more
TLDR
Participation in ironman triathlon often resulted in persistently raised cTnT levels, and the troponin rise was associated with echocardiographic evidence of abnormal left ventricular function.Abstract:
Background: There is concern about whether cardiac damage occurs as a result of prolonged strenuous exercise. Objective: To investigate whether competing in a triathlon is associated with cardiac damage based on a sustained increase in cardiac troponin T (cTnT), and whether such an increase correlates with echocardiographic changes Methods: cTnT and echocardiographic measurements were made in 38 participants in the 2001 Australian ironman triathlon. cTnT was measured the day before, immediately after, and the day following the race. Echocardiography was done the day before, immediately after, and two to six weeks later for measurement of ejection fraction, stroke volume, cardiac output, wall motion analysis, and global left ventricular function (LVF). Results: No subject had detectable cTnT in the pre-race sample. Following the race, 32 subjects (86.5%) had detectable levels of cTnT (>0.01 ng/ml), with six (16.2%) having >0.10 ng/ml. The day after the race, nine subjects (23.7%) still had detectable cTnT, with two recording a level >0.10 ng/ml. Previously described echocardiographic changes of “cardiac fatigue” were observed in the whole cohort. There was a modest but significant correlation between change in ejection fraction and peak cTnT level (p = 0.02, r = 0.39). Athletes with a post-race cTnT >0.10 ng/ml had a greater decrease in global LVF (p = 0.02) and a trend toward a greater fall in ejection fraction and stroke volume than athletes with cTnT levels 0.10 ng/ml (p>0.05). Conclusions: Participation in ironman triathlon often resulted in persistently raised cTnT levels, and the troponin rise was associated with echocardiographic evidence of abnormal left ventricular function. The clinical significance and long term sequelae of such damage remains to be determined.read more
Citations
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Exercise-Induced Cardiac Troponin Elevation: Evidence, Mechanisms, and Implications
Rob Shave,Aaron L. Baggish,Keith George,Malissa J. Wood,Jürgen Scharhag,Gregory P. Whyte,David Gaze,Paul D. Thompson +7 more
TL;DR: A review of the biochemistry, prevalence, potential mechanisms, and management of patients with exercise-induced cardiac troponin (cTn) elevations is presented in this paper.
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Cardiac troponin may be released by ischemia alone, without necrosis
Peter E. Hickman,Julia M. Potter,Julia M. Potter,Con Aroney,Gus Koerbin,Emma Southcott,Alan H.B. Wu,Alan H.B. Wu,Michael S. Roberts,Michael S. Roberts +9 more
TL;DR: Evidence from cardiac studies is presented supporting the presence of membranous blebs, enabling troponin to be released from cardiac cells due to ischemia alone, without necrosis.
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Exercise-induced cardiac troponin T release: a meta-analysis
Rob Shave,Keith George,Greg Atkinson,Emma C. Hart,Natalie Middleton,Greg Whyte,David Gaze,Paul O. Collinson +7 more
TL;DR: Exercise-induced cTnT release is apparent in almost half of the endurance athletes who have been studied to date, and relatively heavy individuals competing in shorter endurance events, primarily running marathons, are slightly more likely to demonstrate elevated cTNT postexercise than other athletes.
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Exercise at the Extremes: The Amount of Exercise to Reduce Cardiovascular Events
TL;DR: This document summarizes available evidence on the relationship between the exercise volume and risk reductions in cardiovascular morbidity and mortality and discusses the controversy of excessive volumes of exercise in the athletic population.
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Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise
TL;DR: The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise andercise training can adversely affect cardiac function in some individuals, and this hypothesis warrants further examination.
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