treat study - improving the interpretation of troponin concentrations following exercise and their clinical significance

Conditions: Coronary Artery Disease

Summary: the goal of this observational study is to learn about cardiac biomarker release following exercise in amateur athletes. the main questions it aims to answer are: question 1: what are the reference values for exercise-induced cardiac troponin elevations following walking, cycling and running exercise? hypothesis 1: we hypothesize that the exercise-induced ctn release is different following walking, cycling and running exercise. therefore, we will establish reference values for post-exercise ctn concentrations across each of these sport types. question 2: is the prevalence of (subclinical) coronary artery disease higher in individuals with high post-exercise cardiac troponin concentrations in comparison to individuals with low post-exercise cardiac troponin concentrations? hypothesis 2: we hypothesize that athletes with the highest post-exercise ctn concentrations have a higher prevalence of coronary atherosclerosis compared to athletes matched for sex and age with the lowest post-exercise ctn concentrations. question 3: what is the association between post-exercise cardiac troponin concentrations and major adverse cardiovascular events (mace) and mortality during long-term follow-up? hypothesis 3: we hypothesize that post-exercise ctn concentrations beyond the 99th percentile are associated with an increased risk for mace and mortality during follow-up. this study consists of three phases: phase 1: two or three visits to the study location for (amongst other measurements) blood draws to assess cardiac troponin concentrations phase 2: ct scan of the heart in 10% of participants to assess the prevalence of (subclinicial) coronary artery disease. phase 3: longitudinal follow-up to assess the incidence of major adverse cardiovascular events and mortality during 20-year follow-up. participants will visit our study centre two, three or four times: visit 1: baseline measurements including height, weight, body composition and blood pressure will be obtained and a blood sample will be drawn. visit 2: a blood sample will be drawn and activity data will be obtained from participants' own sports watch or bike computer. optional visit 3: a blood sample will be drawn. visit 4: 10% of participants will undergo a cardiac ct scan to assess the prevalence of (subclinical) coronary artery disease.

for a detailed description, please see the attached study protocol under 'documents'.

Eligibility criteria:
inclusion criteria: in order to be eligible to participate in this study, a subject must meet all of the following criteria: * participant of an affiliated mass-participation exercise event with a: * walking distance ≥20 km * cycling distance ≥100 km * running distance ≥15 km * age: ≥ 40 and \<70 years old * able to understand and perform study related procedures for phase 2 of the study (i.e. assessment of (sub)clinical coronary artery disease), the following additional criteria are present: • free from (known) cardiovascular diseases exclusion criteria: a potential subject who meets any of the following criteria will be excluded from participation in phase 2 of the study: * renal transplantation in the past * contrast nephropathy in the past * estimated glomerular filtration rate (egfr) \< 30 ml/min * atrial fibrillation (heart rhythm disorder) * previous allergic reaction to iodine contrast * participation in other studies involving radiation * not willing to be informed about potential incidental findings from the ct-scan

Keywords: coronary artery disease exercise athlete troponin radiology biomarker