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Cardiac troponin elevation in athletes: blame the musician and not the instrument
  1. Marc Jean-Gilles1,
  2. Aaron Baggish2
  1. 1 Division of Cardiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
  2. 2 Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Aaron Baggish, Sports Cardiology Program, Lausanne University Hospital, Lausanne, Switzerland; aaron.baggish{at}

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Cardiac troponins (cTn) are a heterogeneous family of intracellular structural proteins that are typically absent from the circulating blood pool in the absence of recent or on-going myocardial injury. The development and wide-spread dissemination of cTn testing revolutionised clinical medicine. Replacing historically useful but non-specific markers of tissue injury including creatine kinase, lactate dehydrogenase and aspartate transaminase, cTn testing enabled prompt and accurate diagnosis of myocardial injury. Prompt cTn testing, when coupled with the appropriate clinical scenario, represents the gold-standard method of documenting acute myocardial injury and, thus, plays an essential role in the diagnosis of acute coronary syndromes and other cardiovascular disease processes. However, not all elevated cTn is created equal and as with any diagnostic tool, pitfalls of clinical application deserve consideration.

A wide body of literature documents the presence of detectable cTn in the blood following moderate to strenuous exercise in people without underlying heart disease.1 An elegant landmark physiology study documented cTn release among healthy young men and women participating in a treadmill-based marathon run.2 Subsequently, a study of recreational Boston marathon runners documented near ubiquitous cTn elevation following race completion.3 Similar findings have now been reproduced across athletes representing numerous endurance and team-sport disciplines. The purpose of this commentary is to examine the potential clinical role and limitations of post-exercise cTn testing in athletes.

Mechanisms of cTn release

Explanatory mechanisms underlying exercise-induced …

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  • Contributors Both authors contributed to the writing and revision of this invited editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.