Elevation of troponin T and echocardiographic abnormalities after prolonged strenuous exercise - the Australian Ironman Triathlon

Louise Tulloh ^1*, Diana Robinson ¹, Anushka Patel ², Amanda Ware ³, Catherine Prendergast ³, David Sullivan ³ and Lynne Pressley ³

¹ North Sydney Orthopaedic and Sports Medicine Centre, Australia
² The George Institute of International Health, University of Sydney, Australia
³ Royal Prince Alfred Hospital, Australia

^* To whom correspondence should be addressed. E-mail: loutulloh{at}optusnet.com.au.

Accepted 16 March 2006

Abstract

Introduction: Concern exists about cardiac damage occurring as a result of prolonged strenuous exercise.

Methods: Cardiac troponin T (cTnT) and echocardiographic measurements in 38 participants in the 2001 Australian Ironman Triathlon were assessed. Cardiac troponin T was measured the day before, immediately after and the day following the race. Echocardiography was performed the day before, immediately after and 2-6 weeks later for measurement of ejection fraction, stroke volume, cardiac output, wall motion analysis and global left ventricular function.

Results: No subject had detectable cTnT in the pre-race sample. Following the race, 32 subjects (86.5%) had detectable levels of cTnT (ie >0.01 ng/ml) with 6 (16.2%) having >0.10 ng/ml. The day after the race, 9 subjects (23.7%) still had detectable cTnT with 2 subjects 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). Those athletes with a post-race cTnT >0.10 ng/ml had a greater decrease in global left ventricular function (p=0.02) and displayed trends toward a greater fall in ejection fraction and stroke volume when compared with those athletes with cTnT levels <0.10 ng/ml. Cardiac output fell in the group with cTnT >0.10ng/ml (p>0.05).

Conclusion: Participation in ironman triathlon frequently results in persistently elevated cTnT levels, and troponin rise is associated with echocardiographic evidence of abnormal left ventricular systolic function. The clinical significance and long-term sequelae of such damage remains to be determined.

Key Words: cardiac troponin T, echocardiograph, exercise, triathlon

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