What is the prevalence and what are the predictors of cardiac troponin elevations following exercise in athletes?
Cardiac troponin elevations above the upper reference limit are common after exercise, occurring in 36% of athletes, and are strongly influenced by assay type and exercise duration.
Abstract Aims Myocardial injury is defined by cardiac troponin (cTn) elevations exceeding the upper reference limit (URL) and serves as a diagnostic criterion for myocardial infarction. However, exercise can also elevate cTn, complicating interpretation. We aimed to determine the prevalence and predictors of cTn elevations following exercise. Methods We conducted a random-effects meta-analysis of post-exercise cTn elevations above the assay-specific URL. Associations between prespecified covariates and the prevalence of elevated post-exercise cTn were assessed using multilevel mixed-effects meta-regression and cubic spline models. Results We identified 4,312 articles and included 129. The cohort consisted of 7,289 athletes (78% male; mean age 44.9 years; median exercise duration 4.2 hours). Overall, 36% (95%CI 31–42%) of athletes demonstrated cTn concentrations above the URL following exercise, with extreme between-study heterogeneity (range 2–98%). The prevalence was higher with high-sensitivity versus non-high-sensitivity assays (58% versus 26%), cTnT versus cTnI assays (45% versus 30%), and in middle-aged individuals. Sex and training status were not associated with elevations. Endurance sports, including triathlon (49%), cycling (40%), and running (41%), showed the highest prevalence, while contact sports (6%) and walking (8%) showed the lowest. The prevalence was non-linearly associated with exercise duration, with a peak (52%) after 3–6 hours of exercise. Conclusions cTn elevations are common following exercise, most often with high-sensitivity assays and cTnT measurements, particularly in endurance sports lasting 3–6 hours. Clinicians should consider assay type and exercise characteristics rather than sex and training status when evaluating post-exercise cTn elevations in athletes.
Stekelenburg et al. (2026) studied this question.