Cardiology Department, Stavanger University Hospital, Norway.
Division of Medicine, Akershus University Hospital, and University of Oslo, Oslo, Norway.
Eur J Prev Cardiol. 2020 Jul;27(11):1212-1221. doi: 10.1177/2047487319852808. Epub 2019 Jun 1.
Sudden cardiac death among middle-aged recreational athletes is predominantly due to myocardial ischaemia. This study examined whether measuring cardiac troponin I and T (cTnI and cTnT) after strenuous exercise could identify occult obstructive coronary artery disease.
Prospective observational study.
Subjects were recruited from 1002 asymptomatic recreational cyclists completing a 91-km mountain bike race (North Sea Race Endurance Exercise Study). No subject had known cardiovascular disease or took cardiovascular medication. Blood samples were collected within 24 h before and 3 h and 24 h after the race. Coronary computed tomography angiography was performed in 80 participants with the highest post-exercise cTnI and in 40 reference subjects with moderately elevated cTnI values.
Study subjects ( = 120) were 45 (36-52) years old and 74% were male. There were similar demographics in the High-cTnI group and the Reference group. The cTn concentrations were highest at 3 h post-race: cTnI, 224 (125-304) ng/L; cTnT, 89 (55-124) ng/L. Nine subjects had obstructive coronary artery disease on coronary computed tomography angiography, eight of whom were High-cTnI responders. Two subjects had myocardial bridging, both High-cTnI responders. Troponin concentrations at 24 h post-race were higher in subjects with obstructive coronary artery disease than in the rest of the cohort ( = 109): cTnI, 151 (72-233) ng/L . 24 (19-82) ng/L, = 0.005; cTnT, 39 (25-55) ng/L . 20 (14-31) ng/L, = 0.002. The areas under the receiver operating characteristic curves for predicting obstructive coronary artery disease were 0.79, = 0.005 (cTnI) and 0.82, = 0.002 (cTnT).
In subjects with occult obstructive coronary artery disease there was a prolonged elevation of cTn following strenuous exercise.
中年业余运动员的心脏性猝死主要是由于心肌缺血所致。本研究旨在探讨剧烈运动后检测心肌肌钙蛋白 I 和 T（cTnI 和 cTnT）是否能发现隐匿性冠状动脉疾病。
前瞻性观察性研究。
从 1002 名无症状的业余自行车手（北海耐力运动研究）中招募受试者，完成 91 公里山地自行车赛。所有受试者均无已知心血管疾病或服用心血管药物。在比赛前 24 小时内和比赛后 3 小时和 24 小时采集血样。在运动后 cTnI 值最高的 80 名受试者和 40 名 cTnI 值中度升高的参考受试者中进行冠状动脉计算机断层扫描血管造影。
研究对象（n=120）年龄为 45（36-52）岁，74%为男性。高 cTnI 组和参考组的人口统计学特征相似。cTn 浓度在运动后 3 小时最高：cTnI，224（125-304）ng/L；cTnT，89（55-124）ng/L。9 名受试者经冠状动脉计算机断层扫描血管造影检查有阻塞性冠状动脉疾病，其中 8 名是高 cTnI 反应者。2 名受试者有心肌桥，均为高 cTnI 反应者。与其余队列相比，有阻塞性冠状动脉疾病的受试者在运动后 24 小时的肌钙蛋白浓度更高（n=109）：cTnI，151（72-233）ng/L 比 109（85-189）ng/L，=0.005；cTnT，39（25-55）ng/L 比 33（24-51）ng/L，=0.002。预测阻塞性冠状动脉疾病的受试者工作特征曲线下面积分别为 0.79，=0.005（cTnI）和 0.82，=0.002（cTnT）。
在隐匿性阻塞性冠状动脉疾病患者中，剧烈运动后 cTn 升高持续时间延长。
