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Proteomics and Protein Markers |
1 Department of Clinical Chemistry, University Hospital Maastricht, Maastricht, the Netherlands, 2 Department of Clinical Chemistry and Haematology, VieCuri Medical Center, Venlo, the Netherlands.
aAddress correspondence to this author at: Department of Clinical Chemistry, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. Fax +31-43-3874692; e-mail dieijen{at}klinchem.azm.nl.
Background: Endurance exercise can increase cardiac troponin (cTn) concentrations as high as those seen in cases of minor myocardial infarction. The inability of most cTn assays to reliably quantify cTn at very low concentrations complicates a thorough data analysis, and the clinical implications of such increases remain unclear. The application of recently developed highly sensitive cTn immunoassays may help resolve these problems.
Methods: We evaluated the precommercial highly sensitive cardiac troponin T (hs-cTnT) assay from Roche Diagnostics and the Architect cardiac troponin I (cTnI-Architect) assay from Abbott Diagnostics by testing samples from a reference population of 546 individuals and a cohort of 85 marathon runners. We also measured the samples with the current commercial cTnT assay for comparison.
Results: Although the hs-cTnT and cTnI-Architect assays were capable of measuring cTn concentrations at low concentrations (<0.01 µg/L), only the hs-cTnT assay demonstrated a CV of <10% at the 99th percentile of the reference population and a near-gaussian distribution of the measurements. After a marathon, 86% of the runners had cTnT concentrations greater than the 99th percentile with the hs-cTnT assay, whereas only 45% of the runners showed increased concentrations with the current cTnT assay. cTn concentrations remained significantly increased the day after the marathon. A multiple regression analysis demonstrated marathon experience and age to be significant predictors of postmarathon cTn concentrations (P < 0.05).
Conclusions: The hs-cTnT assay was the only assay tested with a performance capability sufficient to detect cTn concentrations in healthy individuals. The number of runners with increased cTn concentrations after a marathon depends highly on an assay’s limit of detection (LOD). The assay with the lowest LOD, the hs-cTnT assay, showed that almost all runners had increased cTn concentrations. The clinical implications of these findings require further investigation.
The following articles in journals at HighWire Press have cited this article:
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  L. H. Jacobs, J. J. van de Kerkhof, A. M. Mingels, V. L. Passos, V. W. Kleijnen, A. H. Mazairac, F. M. van der Sande, W. K. Wodzig, C. J. Konings, K. M. Leunissen, et al. Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study Nephrol. Dial. Transplant., January 1, 2010; 25(1): 243 - 248. [Abstract] [Full Text] [PDF]
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 P. A. Kavsak, X. Wang, D. T. Ko, A. R. MacRae, and A. S. Jaffe Short- and Long-Term Risk Stratification Using a Next-Generation, High-Sensitivity Research Cardiac Troponin I (hs-cTnI) Assay in an Emergency Department Chest Pain Population Clin. Chem., October 1, 2009; 55(10): 1809 - 1815. [Abstract] [Full Text] [PDF]
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 T. Reichlin, W. Hochholzer, S. Bassetti, S. Steuer, C. Stelzig, S. Hartwiger, S. Biedert, N. Schaub, C. Buerge, M. Potocki, et al. Early Diagnosis of Myocardial Infarction with Sensitive Cardiac Troponin Assays N. Engl. J. Med., August 27, 2009; 361(9): 858 - 867. [Abstract] [Full Text] [PDF]
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 R. Shave, K. George, and D. Gaze Reply J. Am. Coll. Cardiol., April 14, 2009; 53(15): 1341 - 1342. [Full Text] [PDF]
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