Release of cardiac troponin using a high sensitivity assay after exercise: Type 2 acute myocardial infarction?

• Published in: Clinica chimica acta Vol. 446; pp. 6 - 8
• Main Authors: Aw, Tar Choon, van Wijk, Xander M.R., Wu, Alan H.B., Jaffe, Allan S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.06.2015
• Subjects: Biomarkers - blood; Cardiac troponin; CT angiogram; Exercise - physiology; Female; High sensitivity; Humans; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - diagnostic imaging; Radiography; Troponin I - blood; Troponin T - blood; Type 2 myocardial infarction; CT angiogram; Cardiac troponin; High sensitivity; Type 2 myocardial infarction
• ISSN: 0009-8981; 1873-3492; 1873-3492
• DOI: 10.1016/j.cca.2015.04.002

Cardiac troponin is used as a marker for all types of myocardial infarction. Assays for high-sensitivity troponin T and I were performed before, immediately and 24h after a 40km bicycle ride in two middle aged individuals. There was a significant increase in cardiac troponin immediately after exercise in both individuals. This was accompanied by a return to baseline levels within 24h. A CT angiogram was normal in one while the other had a significant occlusion in the mid-right coronary artery. After a stent placement, in this latter individual, there was no major increase in troponin after a second bicycle ride. Using high sensitivity assays, at least one of these two subjects may have suffered a type 2 myocardial infarction had the increases in hs-cTnI were accompanied by other acceptable evidence of myocardial ischemia (symptoms, ECG, etc.). •High sensitivity troponin can reveal a post-exercise troponin rise in case reports.•Exercise may create an oxygen myocardial supply vs. demand imbalance.•Baseline troponin values are more useful than reference ranges.