title: Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays.
abstract: 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 microg/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.
authors.affiliation: Department of Clinical Chemistry, University Hospital Maastricht, Maastricht, the Netherlands.
authors.forename: Alma
authors.initials: A
authors.lastname: Mingels
authors.forename: Leo
authors.initials: L
authors.lastname: Jacobs
authors.forename: Etienne
authors.initials: E
authors.lastname: Michielsen
authors.forename: Joost
authors.initials: J
authors.lastname: Swaanenburg
authors.forename: Will
authors.initials: W
authors.lastname: Wodzig
authors.forename: Marja
authors.initials: M
authors.lastname: van Dieijen-Visser
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006262:Health; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012044:Regression Analysis; D015203:Reproducibility of Results; D012420:Running / Q000502:physiology*; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T