Cardiac Troponin T Release after Football 7 in Healthy Children and Adults

The objective of this study was to compare the release of cardiac troponin T (cTnT) after a football 7 match between two cohorts of children and adult players. Thirty-six male football players (children = 24, adult = 12) played a football 7 match, and cTnT was measured before, and 3 h after exercise. Concentrations of cTnT were compared between groups and time, and correlated with participants’ characteristics, as well as internal and external exercise load. Cardiac troponin T was elevated in all participants (p < 0.001), and exceeded the upper reference limit for myocardial infarction in 25 (~70%) of them. Baseline concentrations were higher in adults (p < 0.001), but the elevation of cTnT was comparable between the groups (p = 0.37). Age (p < 0.001), body mass (p = 0.001) and height (p < 0.001), and training experience (p = 0.001) were associated to baseline cTnT values, while distance (p < 0.001), mean speed (p < 0.001), and peak (p = 0.013) and mean (p = 0.016) heart rate were associated to the elevation of cTnT. The present study suggests that a football 7 match evoked elevations of cTnT during the subsequent hours in healthy players regardless of their age. However, adults might present higher resting values of cTnT than children. In addition, results suggest that the exercise-induced elevations of cTnT might be mediated by exercise load but not participant characteristics.

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High-Sensitivity Cardiac Troponin T for Risk Stratification in Patients With Embolic Stroke of Undetermined Source

Stroke ◽

10.1161/strokeaha.120.029628 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2386-2394 ◽

Cited By ~ 2

Author(s):

Jan F. Scheitz ◽

Guillaume Pare ◽

Lesly A. Pearce ◽

Hardi Mundl ◽

W. Frank Peacock ◽

...

Keyword(s):

Ischemic Stroke ◽

Risk Stratification ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Embolic Stroke ◽

Cardiac Troponin T ◽

Reference Limit ◽

End Point ◽

Upper Reference Limit

Background and Purpose: Optimal secondary prevention for patients with embolic stroke of undetermined source (ESUS) remains unknown. We aimed to assess whether high-sensitivity cardiac troponin T (hs-cTnT) levels are associated with major vascular events and whether hs-cTnT may identify patients who benefit from anticoagulation following ESUS. Methods: Data were obtained from the biomarker substudy of the NAVIGATE ESUS trial, a randomized controlled trial testing the efficacy of rivaroxaban versus aspirin for secondary stroke prevention in ESUS. Patients were dichotomized at the hs-cTnT upper reference limit (14 ng/L, Gen V, Roche Diagnostics). Cox proportional hazard models were computed to explore the association between hs-cTnT, the combined cardiovascular end point (recurrent stroke, myocardial infarction, systemic embolism, cardiovascular death), and recurrent ischemic stroke. Results: Among 1337 patients enrolled at 111 participating centers in 18 countries (mean age 67±9 years, 61% male), hs-cTnT was detectable in 95% and at/above the upper reference limit in 21%. During a median follow-up of 11 months, the combined cardiovascular end point occurred in 68 patients (5.0%/y, rivaroxaban 28 events, aspirin 40 events; hazard ratio, 0.67 [95% CI, 0.41–1.1]), and recurrent ischemic stroke occurred in 50 patients (4.0%/y, rivaroxaban 16 events, aspirin 34 events, hazard ratio 0.45 [95% CI, 0.25–0.81]). Annualized combined cardiovascular end point rates were 8.2% (9.5% rivaroxaban, 7.0% aspirin) for those above hs-cTnT upper reference limit and 4.8% (3.1% rivaroxaban, 6.6% aspirin) below with a significant treatment modification ( P =0.04). Annualized ischemic stroke rates were 4.7% above hs-cTnT upper reference limit and 3.9% below, with no suggestion of an interaction between hs-cTnT and treatment ( P =0.3). Conclusions: In patients with ESUS, hs-cTnT was associated with increased cardiovascular event rates. While fewer recurrent strokes occurred in patients receiving rivaroxaban, outcomes were not stratified by hs-cTn results. Our findings support using hs-cTnT for cardiovascular risk stratification but not for decision-making regarding anticoagulation therapy in patients with ESUS. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02313909.

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The 99th percentile upper reference limit for the 5th generation cardiac troponin T assay in the United States

Clinica Chimica Acta ◽

10.1016/j.cca.2020.01.027 ◽

2020 ◽

Vol 504 ◽

pp. 172-179

Author(s):

Robert L. Fitzgerald ◽

Judd E. Hollander ◽

W. Frank Peacock ◽

Alexander T. Limkakeng ◽

Nancy Breitenbeck ◽

...

Keyword(s):

United States ◽

Cardiac Troponin ◽

Troponin T ◽

The United States ◽

Cardiac Troponin T ◽

Reference Limit ◽

Upper Reference Limit

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Distribution and specificity of high-sensitivity cardiac troponin T in older adults without acute cardiac conditions: cross-sectional results from the population-based AugUR study

BMJ Open ◽

10.1136/bmjopen-2021-052004 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052004

Author(s):

Alexander Dietl ◽

Martina E Zimmermann ◽

Caroline Brandl ◽

Stefan Wallner ◽

Ralph Burkhardt ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Left Ventricular ◽

Cardiac Troponin T ◽

Cross Sectional ◽

Reference Limit ◽

Mobile Population ◽

Upper Reference Limit

ObjectiveEuropean guidelines recommended a uniform upper reference limit of high-sensitivity cardiac troponin T (hsTnT) to rule out non-ST segment elevation myocardial infarction. Our study aimed to provide a hsTnT reference distribution and to assess the specificity of the 14 ng/L cut-off value in the mobile population ≥70 years of age.DesignA cross-sectional analysis was performed in the German AugUR study (Altersbezogene Untersuchungen zur Gesundheit der University of Regensburg).SettingStudy population was the mobile population aged 70+ years living in the city and county of Regensburg, Germany.ParticipantsA random sample was derived from the local population registries of residence. Of the 5644 individuals invited, 1133 participated (response ratio=20.1%). All participants came to the study centre and were mentally and physically mobile to conduct the protocol (face-to-face interview, blood draw and standardised transthoracic echocardiography). None of the participants was in an acute state of myocardial infarction.ResultsAmong the 1129 individuals with hsTnT measurements (overall median=10.0 ng/L(25th, 75th percentile)=(7.0, 15.0 ng/L)), hsTnT was higher among the older individuals and higher among men (men 70–74 years median=9.6 ng/L (7.2, 13.1 ng/L); men 90–95 years median=21.2 ng/L (14.6, 26.0 ng/L); women 70–74 years median=6.3 ng/L (4.7, 8.7 ng/L); and women 90–95 years median=18.0 ng/L (11.0, 21.0 ng/L)). In participants with impaired kidney function (eGFRcrea <60 mL/min/1.73 m2), hsTnT was elevated (median=13.6 ng/L (9.4, 20.6 ng/L)).Specificity of recommended upper reference limit, 14 ng/L, is 68%. Most false positives were among men aged >79 years (specificity=34%). In a healthy subgroup (n=96, none of the following: overt heart disease, impaired renal function, blood pressure >160/100 mm Hg, left ventricular hypertrophy and diastolic/systolic dysfunction), specificity was 90%.ConclusionIn the elderly population without acute myocardial infarction, hsTnT further increases with age showing different levels for men and women. The specificity of the 14 ng/L cut-off is considerably lower than 99%, even in healthy subjects.

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Measurement of Serum Troponin T, Creatine Kinase MB Isoenzyme, and Total Creatine Kinase following Arduous Physical Training

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456329503200503 ◽

1995 ◽

Vol 32 (5) ◽

pp. 450-453 ◽

Cited By ~ 25

Author(s):

Paul O Collinson ◽

Henry A Chandler ◽

Peter J Stubbs ◽

David S Moseley ◽

David Lewis ◽

...

Keyword(s):

Creatine Kinase ◽

Physical Training ◽

Cardiac Troponin ◽

Troponin T ◽

Myocardial Damage ◽

Enzyme Linked Immunosorbent Assay ◽

Cardiac Troponin T ◽

Reference Limit ◽

Creatine Kinase Mb ◽

Upper Reference Limit

We have compared measurement of cardiac troponin T by enzyme linked immunosorbent assay with creatine kinase MB isoenzyme (CK-MB) concentration measurement in 219 Royal Marine commandos with no evidence of cardiovascular disease who have elevated creatine kinase (CK) produced by arduous physical training. CK was elevated up to 22.6 times and CK-MB mass up to 6.6 times the upper reference limit. Only two commandos had detectable cardiac troponin T, with neither exceeding the upper reference limit of 0.2 μg/L. At decision thresholds optimized for diagnosis of acute myocardial infarction in previous published work, 58.3% of the total CK activity, 13.8% of the CK-MB concentration/CK activity ratio and 1.6% of CK-MB concentration measurements showed elevated values but no elevations in cardiac troponin T occurred. Cardiac troponin T is currently the investigation of choice for the differential diagnosis of patients with an elevated CK due to skeletal muscle trauma to exclude myocardial damage.

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High‐Sensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke

Journal of the American Heart Association ◽

10.1161/jaha.120.018326 ◽

2021 ◽

Author(s):

Jan F. Scheitz ◽

Jess Lim ◽

Leonie H. A. Broersen ◽

Ramanan Ganeshan ◽

Shufan Huo ◽

...

Keyword(s):

Ischemic Stroke ◽

Cardiac Troponin ◽

Primary Outcome ◽

Troponin T ◽

High Sensitivity ◽

Hazard Ratio ◽

Cardiac Troponin T ◽

Vascular Events ◽

Reference Limit ◽

Upper Reference Limit

Background Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high‐sensitivity cardiac troponin T (hs‐cTnT) are associated with recurrent vascular events and death in patients with first‐ever, mild to moderate ischemic stroke. Methods and Results We used data from the PROSCIS‐B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs‐cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all‐cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hs‐cTnT above upper reference limit, 39.2%). During a mean follow‐up of 3 years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of all‐cause death. The primary outcome occurred more often in patients with hs‐cTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3–3.3), with a dose‐response relationship when the highest and lowest hs‐cTnT quartiles were compared (15.2 versus 1.8 events per 100 person‐years; adjusted hazard ratio, 4.8; 95% CI, 1.9–11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex. Conclusions Hs‐cTnT is dose‐dependently associated with an increased risk of recurrent vascular events and death within 3 years after first‐ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs‐cTnT for individualized risk stratification after stroke. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01363856.

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Exercise-Induced Release of Cardiac Troponins in Adolescent vs. Adult Swimmers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031285 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1285

Author(s):

Rafel Cirer-Sastre ◽

Francisco Corbi ◽

Isaac López-Laval ◽

Luis Enrique Carranza-García ◽

Joaquín Reverter-Masià

Keyword(s):

Cardiac Troponin ◽

Healthy Subjects ◽

Troponin T ◽

Training Experience ◽

Post Exercise ◽

Baseline Values ◽

Exercise Induced ◽

Cardiac Troponins ◽

Similar Peak ◽

Apparently Healthy

To examine the exercise-induced release of cardiac troponin T (cTnT) in adolescent and adult swimmers. Thirty-two trained male (18 adolescents, 14 adults) swam at maximal pace in a 45 min distance trial, and blood samples were drawn before, immediately and 3 h after exercise for subsequent cTnT analysis and comparison. Having comparable training experience and baseline values of cTnT (p = 0.78 and p = 0.13), adults exercised at lower absolute and relative intensity (p < 0.001 and p < 0.001, respectively), but presented higher immediate cTnT after exercise than adolescents (p < 0.001). Despite that, peak concentrations were observed at 3 h post exercise and peak elevations were comparable between groups (p = 0.074). Fourteen (44%) apparently healthy subjects exceeded the cutoff value for myocardial infarction (MI). Adolescents presented a delayed elevation of cTnT compared with adults, but achieved similar peak values.

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Exercise-Induced Cardiac Troponin T Release

Medicine & Science in Sports & Exercise ◽

10.1249/mss.0b013e318153ff78 ◽

2007 ◽

Vol 39 (12) ◽

pp. 2099-2106 ◽

Cited By ~ 144

Author(s):

ROBERT SHAVE ◽

KEITH P. GEORGE ◽

GREG ATKINSON ◽

EMMA HART ◽

NATALIE MIDDLETON ◽

...

Keyword(s):

Cardiac Troponin ◽

Troponin T ◽

Cardiac Troponin T ◽

Exercise Induced

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High-Sensitivity Generation 5 Cardiac Troponin T Sex- and Age-Specific 99th Percentiles in the CALIPER Cohort of Healthy Children and Adolescents

Clinical Chemistry ◽

10.1373/clinchem.2018.299156 ◽

2019 ◽

Vol 65 (4) ◽

pp. 589-591 ◽

Cited By ~ 4

Author(s):

Mary Kathryn Bohn ◽

Victoria Higgins ◽

Peter Kavsak ◽

Barry Hoffman ◽

Khosrow Adeli

Keyword(s):

Children And Adolescents ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Healthy Children

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Altered ventricular mechanics after 60 min of high-intensity endurance exercise: insights from exercise speckle-tracking echocardiography

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00917.2014 ◽

2015 ◽

Vol 308 (8) ◽

pp. H875-H883 ◽

Cited By ~ 16

Author(s):

Glenn M. Stewart ◽

Akira Yamada ◽

Luke J. Haseler ◽

Justin J. Kavanagh ◽

Gus Koerbin ◽

...

Keyword(s):

Mean Arterial Pressure ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Left Ventricular ◽

Cardiac Troponin T ◽

Low Intensity ◽

Exercise Challenge ◽

Exercise Induced ◽

Low Intensity Exercise

Transient reductions in myocardial strain coupled with cardiac-specific biomarker release have been reported after prolonged exercise (>180 min). However, it is unknown if 1) shorter-duration exercise (60 min) can perturb cardiac function or 2) if exercise-induced reductions in strain are masked by hemodynamic changes that are associated with passive recovery from exercise. Left ventricular (LV) and right ventricular global longitudinal strain (GLS), LV torsion, and high-sensitivity cardiac troponin T were measured in 15 competitive cyclists (age: 28 ± 3 yr, peak O2 uptake: 4.8 ± 0.6 l/min) before and after a 60-min high-intensity cycling race intervention (CRIT60). At both time points (pre- and post-CRIT60), strain and torsion were assessed at rest and during a standardized low-intensity exercise challenge (power output: 96 ± 8 W) in a semirecumbent position using echocardiography. During rest, hemodynamic conditions were different from pre- to post-CRIT60 (mean arterial pressure: 96 ± 1 vs. 86 ± 2 mmHg, P < 0.001), and there were no changes in strain or torsion. In contrast, during the standardized low-intensity exercise challenge, hemodynamic conditions were unchanged from pre- to post-CRIT60 (mean arterial pressure: 98 ± 1 vs. 97 ± 1 mmHg, not significant), but strain decreased (left ventricular GLS: −20.3 ± 0.5% vs. −18.5 ± 0.4%, P < 0.01; right ventricular GLS: −26.4 ± 1.6% vs. −22.4 ± 1.5%, P < 0.05), whereas LV torsion remained unchanged. Serum high-sensitivity cardiac troponin T increased by 345% after the CRIT60 (6.0 ± 0.6 vs. 20.7 ± 6.9 ng/l, P < 0.05). This study demonstrates that exercise-induced functional and biochemical cardiac perturbations are not confined to ultraendurance sporting events and transpire during exercise that is typical of day-to-day training undertaken by endurance athletes. The clinical significance of cumulative exposure to endurance exercise warrants further study.

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