Duration of Elevated Heart Rate Is an Important Predictor of Exercise-Induced Troponin Elevation

Magnus Bjørkavoll-Bergseth, Øyunn Kleiven, Bjørn Auestad, Trygve Eftestøl, Kay Oskal, Martin Nygård, Øyvind Skadberg, Kristin Moberg Aakre, Tor Melberg, Knut Gjesdal, Stein Ørn, Magnus Bjørkavoll-Bergseth, Øyunn Kleiven, Bjørn Auestad, Trygve Eftestøl, Kay Oskal, Martin Nygård, Øyvind Skadberg, Kristin Moberg Aakre, Tor Melberg, Knut Gjesdal, Stein Ørn

Abstract

Background The precise mechanisms causing cardiac troponin (cTn) increase after exercise remain to be determined. The aim of this study was to investigate the impact of heart rate (HR) on exercise-induced cTn increase by using sports watch data from a large bicycle competition. Methods and Results Participants were recruited from NEEDED (North Sea Race Endurance Exercise Study). All completed a 91-km recreational mountain bike race (North Sea Race). Clinical status, ECG, blood pressure, and blood samples were obtained 24 hours before and 3 and 24 hours after the race. Participants (n=177) were, on average, 44 years old; 31 (18%) were women. Both cTnI and cTnT increased in all individuals, reaching the highest level (of the 3 time points assessed) at 3 hours after the race (P<0.001). In multiple regression models, the duration of exercise with an HR >150 beats per minute was a significant predictor of both cTnI and cTnT, at both 3 and 24 hours after exercise. Neither mean HR nor mean HR in percentage of maximum HR was a significant predictor of the cTn response at 3 and 24 hours after exercise. Conclusions The duration of elevated HR is an important predictor of physiological exercise-induced cTn elevation. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02166216.

Keywords: cardiac troponins; cardiac work; heart rate; physical exercise.

Figures

Figure 1
Figure 1
Diagram of heart rate (HR), altitude, and distance at the 91‐km North Sea Race. HR is outlined in red, and altitude is in gray. The diagram is a representative presentation of HR from a single study participant, and the horizontal line is the subject's mean HR during the race (168 bpm). Distance (in kilometers) is along the x axis. The diagram is exported from the Garmin Connect website (copyright Garmin International, KS, US).
Figure 2
Figure 2
Flowchart depicting the recruitment of the study participants. CAD indicates coronary artery disease; CV, cardiovascular; STEMI, ST‐segment–elevation myocardial infarction.
Figure 3
Figure 3
Scatter plot of cardiac troponin (cTn) values at all postrace time points. The y axis has been modified to allow a representative display of both high and low numbers in the same figure. The timing of blood sampling is represented by the x axis: baseline blood samples were acquired between 24 and 12 hours before the race, whereas blood samples +3 h and +24 h were acquired 3 and 24 hours after the race, respectively. The dotted lines represent the 99th percentile (high‐sensitivity cTnT [hscTnT], 14 ng/L; and high‐sensitivity cTnI [hscTnI], 26 ng/L). The horizontal black lines represent the median value.

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