A long-distance walking event induced remarkably high cardiac troponin I concentrations in a 66-year-old male athlete, whereas a cycling event did not, despite no evidence of ischemia or infarction.
Case Report (n=1)
This case highlights the large intra-individual variability in exercise-induced cardiac troponin elevations and the challenge of differentiating physiological from pathological responses in athletes.
Abstract Background Exercise is known to increase cardiac troponin I (cTnI) concentrations, whereas the magnitude of exercise-induced elevations shows large inter-individual variability. Severely elevated cTnI concentrations post-exercise may be indicative of increased cardiac vulnerability and subclinical cardiovascular pathology. Case summary We present the case of a 66-year-old male recreational endurance athlete that showed remarkably high post-exercise cTnI concentrations after a long-distance walking event, but not after a cycling event. He did not experience any signs or symptoms of cardiac distress. Independently of his cTnI assessments, he underwent cardiac assessment which revealed an intermediate stenosis of the proximal left anterior descending coronary artery, whereas functional testing did not reveal ischemia or infarction. Discussion There is currently no consensus on the clinical interpretation of exercise-induced cTn elevations. Our athlete showed a very high cTnI concentration post-exercise, without evidence of ischemia or myocardial infarction. Accordingly, we summarize other explanations that may have caused the elevated cTnI concentrations, including 1) progression of coronary atherosclerosis, 2) other underlying cardiac conditions, 3) exposure to exercise-related cardiac stress, 4) dehydration, and 5) cardiac vulnerability. This case with large intra-individual difference in post-exercise cTn concentrations illustrates the challenging interpretation of exercise-induced cTn elevations. Future studies examining the underlying mechanisms of exercise-induced cTn release and its clinical sequalae are warranted to improve differentiation between physiological and pathological cTn elevations in athletes.
Padi et al. (2026) conducted a case report in Exercise-induced cardiac troponin I elevation (n=1). Endurance exercise (long-distance walking) vs. Cycling event was evaluated on Post-exercise cardiac troponin I (cTnI) concentrations. A long-distance walking event induced remarkably high cardiac troponin I concentrations in a 66-year-old male athlete, whereas a cycling event did not, despite no evidence of ischemia or infarction.