Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes
Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes
Published by Medscape on July 18, 2025.
Journal:
Journal of the American College of Cardiology (JACC)
Key Findings:
1. Background:
Cardiac troponin (cTn), a marker of heart muscle injury, often rises after intense physical exercise. However, the clinical meaning of these postexercise elevations, especially their link to hidden (occult) coronary artery disease, is unclear.
2. Study Design:
• Included 1,011 middle-aged recreational athletes (median age 56) participating in long-distance sports.
• Measured high-sensitivity troponin T and I (hs-cTnT, hs-cTnI) before and after exercise.
• Selected 68 high responders and 34 low responders for cardiac CT scans to assess coronary atherosclerosis using CAD-RADS and CT-FFR.
3. Results:
• No significant difference in the prevalence or severity of coronary atherosclerosis between high vs low troponin responders:
• CAD-RADS > 0 in 67.6% of high vs 50.0% of low responders.
• Median coronary calcium scores and CT-FFR outcomes were statistically similar.
• Weak correlations were found between postexercise troponin levels and CAD-RADS classifications (R² = 4–8%).
4. Conclusion:
Postexercise elevations in cardiac troponin are not strongly linked to the presence or severity of occult coronary atherosclerosis in recreational middle-aged athletes.
This suggests that most of the variation in exercise-induced troponin response is physiological, not pathological.
Clinical Implication:
High cardiac troponin levels after exercise, even if above clinical thresholds, do not necessarily indicate hidden coronary artery disease in healthy athletes and should be interpreted with caution.
Link: https://www.jacc.org/doi/10.