Male collegiate athletes had a higher prevalence of abnormal baseline hs-cTnI values exceeding the 99th percentile upper reference limit compared to female athletes (28% vs 17%, P<0.01).
Cross-Sectional (n=173)
Baseline hs-cTnI levels in collegiate athletes frequently exceed population-derived 99th percentile upper reference limits, particularly in men and when sampled within 48 hours of exercise, highlighting the need for athlete-specific interpretation.
Absolute Event Rate: 28% vs 17%
p-value: p=< .01
Abstract Objectives Cardiac troponin (cTn) is a critical biomarker for diagnosing myocardial injury; however, intense physical activity can transiently elevate cTn concentrations, creating diagnostic challenges in athletic populations. High-sensitivity cardiac troponin assays (hs-cTn) further complicate discrimination between physiologic and pathologic elevations. Methods This study characterized baseline high-sensitivity cardiac troponin I (hs-cTnI) distributions in collegiate athletes and evaluated associations with sex, time since exercise, sport type, and creatine kinase–MB (CK-MB). We analyzed baseline hs-cTnI values from 173 elite collegiate athletes (98 women, 75 men) representing 21 sports. Results The median hs-cTnI concentration (4 ng/L) was identical between sexes, but divergence emerged in the upper distribution tail, with hs-cTnI values exceeding population-derived 99th percentile upper reference limits occurring at lower percentiles in men than women (73rd vs 85th percentile), resulting in a higher prevalence of abnormal classifications in men (28% vs 17%, P .01). Ninety-fifth percentile values were similar between sexes, whereas divergence was confined to the extreme upper tail (99th percentile). Abnormal hs-cTnI values were more frequent when samples were collected 48 hours after exercise compared with ≥48 hours (29% vs 16%, P = .04). No association was observed between hs-cTnI and CK-MB (P = .37). Significant differences emerged between sports (P = .02), with the highest proportions of abnormal hs-cTnI observed among cross-country (80%), sailing (44%), and rowing (35%) athletes. Conclusions These findings support athlete-focused interpretation of hs-cTnI incorporating sex-specific thresholds, standardized postexercise sampling, and sport context. Such tailored approaches may reduce false-positive results and unnecessary evaluations while preserving diagnostic accuracy for true myocardial pathology.
Jamal et al. (2026) conducted a cross-sectional in Healthy collegiate athletes (n=173). Male sex vs. Female sex was evaluated on Prevalence of abnormal hs-cTnI classifications (exceeding population-derived 99th percentile upper reference limits) (p=< .01). Male collegiate athletes had a higher prevalence of abnormal baseline hs-cTnI values exceeding the 99th percentile upper reference limit compared to female athletes (28% vs 17%, P<0.01).