Physical Exercise Increases Cardiac Troponin (cTn) Levels as a Marker of Myocardial Infarction: A Systematic Review
DOI:
https://doi.org/10.17309/tmfv.2024.4.20Keywords:
cardiac troponin, physical exercise, myocardial infarction, healthy lifestyleAbstract
Objectives. This study aimed to analyze an indication of physical exercise on the increase of cardiac troponin (cTn) levels as a marker of myocardial infarction from the physiological perspective.
Materials and methods. A search of journal databases including MEDLINE-Pubmed, Web of Science, Scopus, and Science Direct was used in this systematic review study. The inclusion criteria were papers that addressed cardiac troponin (cTn), physical activity, and myocardial infarction, and were published within the last five years. Using the databases Science Direct, Pubmed, and Web of Science, 83 recognized publications were found. For this systematic review, finally ten publications that fulfilled the requirements for inclusion were chosen and examined. This study evaluated standard operating procedures using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).
Results. This systematic review reports that physical exercise has been found to increase cardiac troponin (cTn) levels as a marker of myocardial infarction, but this increase is triggered by the body’s physiological response during exercise and is not considered as a pathological response.
Conclusions. According to the findings of the study, physical exercise has been proven to elevate the risk of heart muscle damage by triggering an increase in cardiac troponin (cTn). However, this feature occurs in a physiological state and represents an exercise adaptation process. An analysis of the relevant articles reveals that this increase in cardiac troponin (cTn) has not been shown to have a negative influence on developing cardiovascular disease.
Downloads
References
Ekelund, U., Tarp, J., Steene-Johannessen, J., Hansen, B. H., Jefferis, B., Fagerland, M. W., Whincup, P., Diaz, K. M., Hooker, S. P., Chernofsky, A., Larson, M. G., Spartano, N., Vasan, R. S., Dohrn, I. M., Hagströmer, M., Edwardson, C., Yates, T., Shiroma, E., Anderssen, S. A., & Lee, I. M. (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: Systematic review and harmonised meta-analysis. The BMJ, 366, 1-10. https://doi.org/10.1136/bmj.l4570 DOI: https://doi.org/10.1136/bmj.l4570
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J. P., Chastin, S., Chou, R., Dempsey, P. C., Dipietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451-1462. https://doi.org/10.1136/bjsports-2020-102955 DOI: https://doi.org/10.1136/bjsports-2020-102955
Pelliccia, A., Sharma, S., Gati, S., Bäck, M., Börjesson, M., Caselli, S., Collet, J.-P., Corrado, D., Drezner, J. A., Halle, M., Hansen, D., Heidbuchel, H., Myers, J., Niebauer, J., Papadakis, M., Piepoli, M. F., Prescott, E., Roos-Hesselink, J. W., Graham Stuart, A., … Rakhit, D. (2021). 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. European Heart Journal, 42(1), 17–96. https://doi.org/10.1093/eurheartj/ehaa605 DOI: https://doi.org/10.1016/j.rec.2021.05.003
Franklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M. F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., & Eijsvogels, T. M. H. (2020). Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks into Perspective-An Update: A Scientific Statement from the American Heart Association. Circulation, 141(13). https://doi.org/10.1161/CIR.0000000000000749 DOI: https://doi.org/10.1161/CIR.0000000000000749
Paul-Hus, A., & Desrochers, N. (2019). Acknowledgements are not just thank you notes: A qualitative analysis of acknowledgements content in scientific articles and reviews published in 2015. PLoS ONE, 14(12), 1-13. https://doi.org/10.1371/journal.pone.0226727 DOI: https://doi.org/10.1371/journal.pone.0226727
Janssen, S. L., Berge, K., Luiken, T., Aengevaeren, V. L., & Eijsvogels, T. M. (2023). Cardiac troponin release in athletes: what do we know and where should we go? Current Opinion in Physiology, 31(January), 100629. https://doi.org/10.1016/j.cophys.2022.100629 DOI: https://doi.org/10.1016/j.cophys.2022.100629
Donaldson, J. A., Wiles, J. D., Coleman, D. A., Papadakis, M., Sharma, R., & O’Driscoll, J. M. (2019). Left Ventricular Function and Cardiac Biomarker Release—The Influence of Exercise Intensity, Duration and Mode: A Systematic Review and Meta-Analysis. Sports Medicine, 49(8), 1275-1289. https://doi.org/10.1007/s40279-019-01142-5 DOI: https://doi.org/10.1007/s40279-019-01142-5
Kleiven, Ø., Omland, T., Skadberg, Ø., Melberg, T. H., Bjørkavoll-Bergseth, M. F., Auestad, B., Bergseth, R., Greve, O. J., Aakre, K. M., & Ørn, S. (2020). Occult obstructive coronary artery disease is associated with prolonged cardiac troponin elevation following strenuous exercise. European Journal of Preventive Cardiology, 27(11), 1212-1221. https://doi.org/10.1177/2047487319852808 DOI: https://doi.org/10.1177/2047487319852808
Aakre, K. M., & Omland, T. (2019). Physical activity, exercise and cardiac troponins: Clinical implications. Progress in Cardiovascular Diseases, 62(2), 108-115. https://doi.org/10.1016/j.pcad.2019.02.005 DOI: https://doi.org/10.1016/j.pcad.2019.02.005
Aengevaeren, V. L., Hopman, M. T. E., Thompson, P. D., Bakker, E. A., George, K. P., Thijssen, D. H. J., & Eijsvogels, T. M. H. (2019). Exercise-Induced Cardiac Troponin I Increase and Incident Mortality and Cardiovascular Events. Circulation, 140(10), 804-814. https://doi.org/10.1161/CIRCULATIONAHA.119.041627 DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.041627
Tesema, G., & George, M. (2021). Associations between cardiac troponin i and cardiovascular parameters after 12-week endurance training in young moderately trained amateur athletes. BMJ Open Sport and Exercise Medicine, 7(1), 14-16. https://doi.org/10.1136/bmjsem-2021-001065 DOI: https://doi.org/10.1136/bmjsem-2021-001065
Nguyen, D. K., Ellingsen, Ø., Grenne, B., Fremo, T., Hov, G. G., Røsbjørgen, R., & Mikkelsen, G. (2023). Treadmill running intensity and post-exercise increase in plasma cardiac troponin I and T—A pilot study in healthy volunteers. Scandinavian Journal of Medicine and Science in Sports, 33(12), 2499-2508. https://doi.org/10.1111/sms.14484 DOI: https://doi.org/10.1111/sms.14484
Kastner, T., Frohberg, F., Hesse, J., & Wolfarth, B. (2024). Exercise-Induced Troponin Elevation in High-Performance Cross-Country Skiers. DOI: https://doi.org/10.3390/jcm13082335
Orn, S., Melberg, T. ., Omland, T., Skadberg, O., Bjorkavoll-Bergseth, M. ., Erevik, C. ., Hansen, M. ., Auestad, B., Bergseth, R., Aakre, K. ., & Kleiven, O. (2020). Is cardiac troponin elevation following strenuous exercise clinically relevant in healthy subjects? European Heart Journal, 41(Supplement_2), 3121. https://doi.org/10.1093/ehjci/ehaa946.3121 DOI: https://doi.org/10.1093/ehjci/ehaa946.3121
Bjorkavoll-Bergseth, M., Erevik, C., Kleiven, Ø., Wiktorski, T., Auestad, B., Skadberg, Ø., Aakre, K. M., Eijsvogels, T. M. H., & Ørn, S. (2024). The relationship between workload and exercise-induced cardiac troponin elevations is influenced by non-obstructive coronary atherosclerosis. Scandinavian Journal of Medicine and Science in Sports, 34(5), 1-13. https://doi.org/10.1111/sms.14667 DOI: https://doi.org/10.1111/sms.14667
Janssen, S. L. J. E., De Vries, F., Mingels, A. M. A., Kleinnibbelink, G., Hopman, M. T. E., Mosterd, A., Velthuis, B. K., Aengevaeren, V. L., & Eijsvogels, T. M. H. (2024). Exercise-induced cardiac troponin release in athletes with versus without coronary atherosclerosis. American Journal of Physiology - Heart and Circulatory Physiology, 326(4), H1045–H1052. https://doi.org/10.1152/ajpheart.00021.2024 DOI: https://doi.org/10.1152/ajpheart.00021.2024
Paana, T., Jaakkola, S., Bamberg, K., Saraste, A., Tuunainen, E., Wittfooth, S., Kallio, P., Heinonen, O. J., Knuuti, J., Pettersson, K., & Airaksinen, K. E. J. (2019). Cardiac troponin elevations in marathon runners. Role of coronary atherosclerosis and skeletal muscle injury. The MaraCat Study. International Journal of Cardiology, 295, 25-28. https://doi.org/10.1016/j.ijcard.2019.08.019 DOI: https://doi.org/10.1016/j.ijcard.2019.08.019
Cirer-Sastre, R., Corbi, F., López-Laval, I., Carranza-García, L. E., & Reverter-Masià, J. (2021). Exercise-induced release of cardiac troponins in adolescent vs. Adult swimmers. International Journal of Environmental Research and Public Health, 18(3), 1-6. https://doi.org/10.3390/ijerph18031285 DOI: https://doi.org/10.3390/ijerph18031285
Cirer-Sastre, R., Legaz-Arrese, A., Corbi, F., George, K., Nie, J., Carranza-García, L. E., & Reverter-Masià, J. (2019). Cardiac biomarker release after exercise in healthy children and adolescents: A systematic review and meta-analysis. Pediatric Exercise Science, 31(1), 18-36. https://doi.org/10.1123/pes.2018-0058 DOI: https://doi.org/10.1123/pes.2018-0058
Cirer-Sastre, R., Legaz-Arrese, A., Corbi, F., López-Laval, I., Puente-Lanzarote, J., Hernández-González, V., & Reverter-Masià, J. (2019). Effect of training load on post-exercise cardiac troponin T elevations in young soccer players. International Journal of Environmental Research and Public Health, 16(23). https://doi.org/10.3390/ijerph16234853 DOI: https://doi.org/10.3390/ijerph16234853
Birat, A., Bourdier, P., Dodu, A., Grossoeuvre, C., Blazevich, A. J., Amiot, V., Dupont, A. C., Nottin, S., & Ratel, S. (2020). Effect of Long-Duration Adventure Races on Cardiac Damage Biomarker Release and Muscular Function in Young Athletes. Frontiers in Physiology, 11(February), 1-9. https://doi.org/10.3389/fphys.2020.00010 DOI: https://doi.org/10.3389/fphys.2020.00010
Baker, P., Leckie, T., Harrington, D., & Richardson, A. (2019). Exercise-induced cardiac troponin elevation: An update on the evidence, mechanism and implications. IJC Heart and Vasculature, 22, 181-186. https://doi.org/10.1016/j.ijcha.2019.03.001 DOI: https://doi.org/10.1016/j.ijcha.2019.03.001
Celeski, M., Segreti, A., Piscione, M., Monticelli, L. M., Di Gioia, G., Fossati, C., Ussia, G. P., Pigozzi, F., & Grigioni, F. (2024). The current paradigm of cardiac troponin increase among athletes. Monaldi Archives for Chest Disease. https://doi.org/10.4081/monaldi.2024.2878 DOI: https://doi.org/10.4081/monaldi.2024.2878
Aengevaeren, V. L., Baggish, A. L., Chung, E. H., George, K., Kleiven, Ø., Mingels, A. M. A., Ørn, S., Shave, R. E., Thompson, P. D., & Eijsvogels, T. M. H. (2021). Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance. Circulation, 144(24), 1955-1972. https://doi.org/10.1161/CIRCULATIONAHA.121.056208 DOI: https://doi.org/10.1161/CIRCULATIONAHA.121.056208
Heusch, G. (2019). Myocardial ischemia: Lack of coronary blood flow, myocardial oxygen supply-demand imbalance, or what? American Journal of Physiology - Heart and Circulatory Physiology, 316(6), H1439-H1446. https://doi.org/10.1152/ajpheart.00139.2019 DOI: https://doi.org/10.1152/ajpheart.00139.2019
Taggart, C., & Chapman, A. R. (2024). Cardiac troponin and the diagnosis of type 2 myocardial infarction and acute non-ischaemic myocardial injury. Journal of Laboratory and Precision Medicine, 9. https://doi.org/10.21037/jlpm-23-40 DOI: https://doi.org/10.21037/jlpm-23-40
Chen, H., Chen, C., Spanos, M., Li, G., Lu, R., Bei, Y., & Xiao, J. (2022). Exercise training maintains cardiovascular health: signaling pathways involved and potential therapeutics. Signal Transduction and Targeted Therapy, 7(1). https://doi.org/10.1038/s41392-022-01153-1 DOI: https://doi.org/10.1038/s41392-022-01153-1
Ezzatvar, Y., Izquierdo, M., Núñez, J., Calatayud, J., Ramírez-Vélez, R., & García-Hermoso, A. (2021). Cardiorespiratory fitness measured with cardiopulmonary exercise testing and mortality in patients with cardiovascular disease: A systematic review and meta-analysis. Journal of Sport and Health Science, 10(6), 609-619. https://doi.org/10.1016/j.jshs.2021.06.004 DOI: https://doi.org/10.1016/j.jshs.2021.06.004
Li, H., Trager, L. E., Liu, X., Hastings, M. H., Xiao, C., Guerra, J., To, S., Li, G., Yeri, A., Rodosthenous, R., Silverman, M. G., Das, S., Ambardekar, A. V., Bristow, M. R., González-Rosa, J. M., & Rosenzweig, A. (2022). LncExACT1 and DCHS2 Regulate Physiological and Pathological Cardiac Growth. Circulation, 145(16), 1218-1233. https://doi.org/10.1161/CIRCULATIONAHA.121.056850 DOI: https://doi.org/10.1161/CIRCULATIONAHA.121.056850
Hussey, C., & Gupta, A. (2023). Physical activity and its impact on the health of young people. December.
Moscatelli, F., Sessa, F., Valenzano, A., Polito, R., Eronia, S., & Monda, V. (2022). The Influence of Physical Exercise, Stress and Body Composition on Autonomic Nervous System: A Narrative Review. Sport Mont, 20(2), 131-134. https://doi.org/10.26773/smj.220620 DOI: https://doi.org/10.26773/smj.220620
Er, F., Yilmaz, C., Polat, M., Kuzucu, Ö. E., & Suveren, C. (2024). Effect of Physical Exercise on Catecholamine Levels in Individuals over 65 Years of Age. International Journal of Human Movement and Sports Sciences, 12(3), 463–470. https://doi.org/10.13189/saj.2024.120302 DOI: https://doi.org/10.13189/saj.2024.120302
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Novadri Ayubi, Junian Cahyanto Wibawa, Mohammed Aljunaid; Procopio B. Dafun Jr.; Heru Syarli Lesmana
This work is licensed under a Creative Commons Attribution 4.0 International License.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
