In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
B ie Repo
Exe cise-Induced Release o Ca diac T oponins in Adolescen
s. Adul Swimme s
Ra el Ci e -Sas e 1,* , F ancisco Co bi 1, Isaac López-La al 2, Luis En ique Ca anza-Ga cía3
and Joaquín Re e e -Masià4


Ci a ion: Ci e -Sas e, R.; Co bi, F.;
López-La al, I.; Ca anza-Ga cía, L.E.;
Re e e -Masià, J. Exe cise-Induced
Release o Ca diac T oponins in
Adolescen s. Adul Swimme s. In .
J. En i on. Res. Public Heal h 2021,18,
1285. h ps://doi.o g/10.3390/
ije ph18031285
Academic Edi o : Tadeusz Amb ozy
Recei ed: 28 Decembe 2020
Accep ed: 26 Janua y 2021
Published: 1 Feb ua y 2021
Publishe ’s No e: MDPI s ays neu al
wi h ega d o ju isdic ional claims in
published maps and ins i u ional a il-
ia ions.
Copy igh : © 2021 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
1Ins i u Nacional d’EducacióFísica de Ca alunya (INEFC), Uni e si a de Lleida (UdL), 25192 Lleida, Spain;
[email p o ec ed]
2Facul ad de Ciencias de la Salud y del Depo e, Uni e sidad de Za agoza, 50009 Za agoza, Spain;
isaac@uniza .es
3Facul ad de O ganización Depo i a (FOD), Uni e sidad Au ónoma de Nue o León (UANL),
San Nicolás de los Ga za 66455, Mexico; [email p o ec ed]
4Depa amen de Didàc iques Especí iques, Uni e si a de Lleida (UdL), 25003 Lleida, Spain;
[email p o ec ed]
*Co espondence: [email p o ec ed]; Tel.: +34-973-27-20-22
Abs ac :
To examine he exe cise-induced elease o ca diac oponin T (cTnT) in adolescen and
adul swimme s. Thi y- wo ained male (18 adolescen s, 14 adul s) swam a maximal pace in a
45 min dis ance ial, and blood samples we e d awn be o e, immedia ely and 3 h a e exe cise o
subsequen cTnT analysis and compa ison. Ha ing compa able aining expe ience and baseline
alues o cTnT (p= 0.78 and p= 0.13), adul s exe cised a lowe absolu e and ela i e in ensi y
(p< 0.001 and p< 0.001, espec i ely), bu p esen ed highe immedia e cTnT a e exe cise han
adolescen s (p< 0.001). Despi e ha , peak concen a ions we e obse ed a 3 h pos exe cise and peak
ele a ions we e compa able be ween g oups (p= 0.074). Fou een (44%) appa en ly heal hy subjec s
exceeded he cu o alue o myoca dial in a c ion (MI). Adolescen s p esen ed a delayed ele a ion
o cTnT compa ed wi h adul s, bu achie ed simila peak alues.
Keywo ds: bioma ke s; hea damage; swimming; g ow h
1. In oduc ion
Ele a ions o se um ca diac oponin (cTn) a e he p e e ed c i e ia o diagnose my-
oca dial inju y [
1
]. Conc e ely, he elease o cTn in o he bloods eam has been ela ed o
di e en clinical scena ios and explained by mechanisms o elease such as myoca dial
ischemia, in lamma o y and immunological p ocesses, auma, d ugs o oxins [
1
,
2
]. I is
o pa icula in e es hough ha exe cise equen ly e okes ele a ions o se um ca diac
oponin (cTn), ha peak app oxima ely 3 h a e exe cise and e u n o basal concen a-
ions wi hin he subsequen 24 h [
3
]. Fu he mo e, a g owing body o e idence sugges s
ha cTn ele a ions induced by exe cise occu in appa en ly heal hy a hle es and migh
espond o a physiological acu e esponse o exe cise a he han pa hological sign [
2
–
4
].
Al hough he mechanisms unde lying he elease o cTn ollowing exe cise in appa en ly
heal hy indi iduals a e no comple ely unde s ood, p e ious esea ch sugges ed po en ial
mechanisms, among hem: changes in memb ane pe meabili y allowing unbound cTn om
cy osol o di use ou side he cells, no mal u no e o myoca dial cells, cTn deg ada ion
p oducing cellula elease, memb anous blebs, myocy e apop osis/nec osis esul ing in
genuine ca diac inju y o c oss- eac ion wi h skele al oponin [3,5].
Pos -exe cise ele a ions o cTn ha e been no ed also in adolescen a hle es [
6
]. How-
e e , di e ences be ween adolescen s and adul s a e inconsis en [
4
,
6
–
8
]. In his ega d,
i has been p e iously sugges ed ha highe exe cise-induced ele a ions o cTn in he
younge migh be a ibu able o he imma u i y o adolescen s myoca dium, since i
In . J. En i on. Res. Public Heal h 2021,18, 1285. h ps://doi.o g/10.3390/ije ph18031285 h ps://www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2021,18, 1285 2 o 6
would expe ience g ea e s ess in esponse o an inc eased myoca dial wo kload com-
pa ed wi h he adul s [
9
]. Based on his hypo hesis, i is possible ha younge a hle es
espond o exe cise wi h highe ele a ions o his bioma ke han adul s. No wi hs anding
ha , p io li e a u e has also linked exe cise-induced ele a ions o cTn abo e he uppe
e e ence limi o highe mo ali y and ca dio ascula e en s in olde a hle es [
10
]. In his
case, highe ele a ions in he olde migh be ela ed o unde lying, subclinical, ca diac
pa hology [11].
Unde s anding how, when, and why cTn ele a es a e exe cise is ele an o he
iage o a hle es who de elop ches pain ha mimics ca diac inju y a e exe cise, and
who migh ha e se um cTn d awn in he eme gency depa men s (EDs). Fu he mo e,
a be e knowledge o he ela ionship be ween exe cise-induced ele a ions o cTn and
pa icipan s’ age migh con ibu e o a be e unde s anding o he phenomenon and i s
mechanisms. Fo hese easons, he pu pose o his s udy was o compa e he elease o
cTnT a e a dis ance- ial es o 45 min swimming be ween wo coho s o adolescen and
adul swimme s. Based on p e ious s udies, ou hypo hesis was ha adolescen s would
espond o exe cise wi h highe peak ele a ions o cTn, suppo ing he heo y ha he
imma u e myoca dium expe iences highe wo kload compa ed wi h he adul s.
2. Ma e ials and Me hods
2.1. Pa icipan s
A con enience sample o hi y- wo ained male swimme s we e ec ui ed o his
s udy. All pa icipan s and pa en s o hose unde he age o 18 p o ided hei in o med
consen . All swimme s ained in he same club and compe ed a he egional le el.
Pa icipan s we e di ided in o adolescen (<18 yea s) and adul (
≥
18 yea s) g oups (see
pa icipan cha ac e is ics in Table 1). The s udy was app o ed by he E hical Commi ee
o Clinical Resea ch o Spo s Adminis a ion o Ca alonia (02/2018/CEICGC).
Table 1. Summa y o pa icipan s’ cha ac e is ics and exe cise load.
Adolescen s (n= 18) Adul s (n= 14) Be ween-G oups
Pa icipan Cha ac e is ics
Age (yea s) 14 ±3 [11–17] 35 ±9 [23–52] p < 0.001
T aining expe ience (yea s) 7 ±2 [2–11] 6 ±2 [4–9]p= 0.78
Body heigh (cm) 172.3 ±9.6 [151–187] 177.4 ±5.5 [169–187] p= 0.065
Body mass (kg) 60.6 ±10.2 [44.5–77.8] 71 ±4.4 [66–81] p < 0.001
Body mass index 20.3 ±2.2 [16.9–24.3] 26.6 ±1.3 [20–24.8] p= 0.001
Exe cise Load
Dis ance (m) 1862 ±276 [1250–2300] 1650 ±239 [1320–2060] p= 0.027
Mean ela i e hea a e (% HRmax) 89 ±5 [75–99] 82 ±4 [75–88] p< 0.001
Peak ela i e hea a e (% HRmax) 95 ±6 [82–110] 91 ±4 [82–96] p= 0.037
Ra ing o pe cei ed exe ion 7 ±2 [3–10] 8 ±1 [6–10] p= 0.24
Ca diac T oponin
Basal cTnT (ng/L) 5.39 (2.15) [1.5–8.09] 3.93 (3.97) [1.5–6.07] p= 0.13
∆0 h pos -exe cise cTnT (ng/L) 0.38 (0.62) [−0.46–2.41] 3.69 (2.78) [0.57–9.25) p< 0.001
∆3 h pos -exe cise cTnT (ng/L) 5.08 (6.37) [1.07–34.67) 11.64 (13.62) [2.83–38.84] p= 0.074
Pa icipan cha ac e is ics and exe cise load da a a e desc ibed as mean
±
s anda d de ia ion [ ange], whe eas cTn da a a e desc ibed
as median (in e qua ile ange) [ ange].
∆
0 h pos -exe cise cTnT, absolu e change om baseline o immedia ely a e exe cise;
∆
3 h
pos -exe cise cTnT, absolu e change om baseline o 3 h pos -exe cise.
2.2. P ocedu es
Be o e he in e en ion, pa icipan s unde wen an h opome ic assessmen and a
es ing 12-lead elec oca diog am (Click ECG BT 12 channel, Milano, I aly). Swimme s
pe o med a sel -paced 5 min swimming wa m-up (<60% o %HRmax) [
6
], ollowed by a
dis ance- ial es o 45 min con inuous swimming, and enous blood samples we e d awn
be o e, immedia ely and a 3 h a e exe cise. Pa icipan s we e asked o a oid igo ous
In . J. En i on. Res. Public Heal h 2021,18, 1285 3 o 6
exe cise du ing he 48 h p io o he in e en ion. Se um cTnT was de e mined using a
T oponin T hs STAT immunoassay in a Cobas E 601 analyze (Roche Diagnos ics, Penzbe g,
Ge many, ange 3–10,000 ng/L). The uppe e e ence limi o cTnT was 13.5 ng/L [
11
].
Concen a ions below he limi o de ec ion we e se o 1.5 ng/L o s a is ical analyses.
Hea a e du ing he es was eco ded using Pola OH1
™
op ical hea a e senso s (Pola
Elec o Oy, Kempele, Finland). Maximum hea a e o ela i e in ensi ies was calcula ed
using Tanaka’s o mula o 208
−
(0.7
×
Age). A yea a e he in e en ion, pa icipan s
we e in e iewed o iden i y cases o ca diac signs o symp oms.
2.3. S a is ical Analysis
Analyses we e pe o med using R e sion 3.5.1 (R Founda ion o S a is ical Com-
pu ing, Vienna, Aus ia). Da a we e isually inspec ed o de ec abno mal alues, and
Shapi o-Wilk es was used o assess no mali y. Acco dingly, da a we e p esen ed as mean
±
SD [ ange] o median (in e qua ile ange) [ ange], as app op ia e. Pa icipan cha ac e -
is ics and exe cise load we e compa ed among g oups using - es o independen samples.
Then, ime di e ences wi hin each g oup we e compa ed using non-pa ame ic F iedman
es o epea ed measu es and pai wise compa isons be ween momen s we e made wi h
Wilcoxon signed ank es s applying Bon e oni co ec ions. Di e ences be ween g oups in
absolu e cTn and i s changes (
∆
0 h and
∆
3 h) we e analyzed using K uskal-Wallis ank
sum es . Associa ions be ween cTn ele a ions and he es o he a iables we e assessed
using Spea man co ela ion coe icien s (
ρ
). S a is ical signi icance in all compa isons was
assumed when p< 0.05.
3. Resul s
Pa icipan cha ac e is ics and exe cise load du ing he dis ance ial a e summa ized
in Table 1. The e we e g oup di e ences in age, body mass, body mass index and maximal
hea a e, and aining expe ience was compa able be ween g oups. Du ing he dis ance
ial, adolescen s co e ed mo e dis ance and achie ed highe ca diac in ensi y han adul s,
hough he a ing o pe cei ed exe ion was compa able be ween g oups.
Concen a ions o cTnT changed signi ican ly o e ime (
χ2
= 59.5, p< 0.001). Con-
c e ely, baseline concen a ions we e compa able be ween adolescen s and adul s (
χ2= 2.2;
p= 0.13), and in bo h g oups i aised immedia ely a e and a 3 h pos exe cise. Fu -
he mo e, immedia e changes (
∆
0 h) we e di e en be ween g oups (
χ2
= 18.1; p< 0.001),
sligh ly highe in he adul s (Figu e 1). Peak changes (
∆
3 h), howe e , we e compa able
be ween g oups (
χ2
= 3.2; p= 0.074). Peak cTnT concen a ions we e obse ed a 3 h pos -
exe cise in all pa icipan s, and 14 (44%) subjec s exceeded he cu o alue o myoca dial
in a c ion (MI) (6 (33%) adolescen s, 8 (57%) adul s). Peak changes (
∆
3 h) we e unco ela ed
wi h age (
ρ
= 0.19, p= 0.29), aining expe ience (
ρ
=
−
0.21, p= 0.24), body mass index
(
ρ= 0.05
,p= 0.8), dis ance (
ρ
=
−
0.1, p= 0.59), peak hea a e (
ρ
= 0.06,
p= 0.74
), and mean
hea a e (ρ= 0.06, p= 0.73).
In . J. En i on. Res. Public Heal h 2021,18, 1285 4 o 6
In . J. En i on. Res. Public Heal h 2021, 18, x 4 o 6
Figu e 1. Indi idual poin s o cTnT by g oup. Red ho izon al line and ed do s deno e he cu o
alue o myoca dial in a c ion (MI) o 13.5 ng/L and abo e alues, espec i ely.
4. Discussion
The pu pose o his s udy was o compa e he exe cise-induced elease o cTnT be-
ween adolescen s and adul s. Ou main inding was ha , al hough ha ing compa able
aining expe ience and baseline alues o cTnT, adul s exe cised a lowe absolu e and
ela i e in ensi y, bu p esen ed highe immedia e concen a ions o cTnT a e exe cise
han adolescen s. Howe e , peak concen a ions we e obse ed a 3 h pos exe cise in all
pa icipan s and we e compa able be ween g oups.
Re e ence alues o cTn seem o be lowe in he young, and his migh be explained
by a posi i e associa ion be ween age and he p e alence o ca dio ascula diseases [4,11].
Howe e , ou esul s did no suppo hose p e ious s a emen s since swimme s had
compa able basal concen a ions o cTnT. E en hough his s udy was limi ed by a small
sample size, i is no he i s esea ch inding no age-di e ences in appa en ly heal hy,
ained, young pa icipan s [7]. In e es ingly hough, al hough peak cTnT was ound in
all pa icipan s a 3 h pos exe cise, we de ec ed highe ele a ions immedia ely a e exe -
cise in he adul s. Since peak ele a ions we e compa able among g oups, his sugges s
ha se ological cTnT ele a ions migh appea ea lie a e exe cise in adul s compa ed
wi h adolescen s.
I has been sugges ed ha highe concen a ions o pos -exe cise cTn in he olde may
ep esen myoca dial inju y because o unde lying, subclinical, ca diac pa hology [11].
Howe e , all pa icipan s in his s udy had no mal es ing ECG a he beginning o he
s udy. Fu he mo e, one yea a e he in e en ion, none o hem epo ed o ha e had
ca diac symp oms o e en s du ing his pe iod. Assuming ha ou pa icipan s we e
heal hy, hese e idences align wi h he heo y o ansien ele a ions o cTnT a e exe cise
being a physiological acu e esponse o exe cise a he han a sign o myoca dial inju y
[3]. Howe e , his s udy did no include o he examina ions o myoca dial heal h such as
echoca diog aphies o o he bioma ke assessmen s such as N- e minal p oho mone o
b ain na iu e ic pep ide (NT-p oBNP), c ea ine kinase myoca dial band (CK-MB), o c-
eac i e p o ein (CRP). Due o his limi a ion, we canno be ce ain o disca d a possible
ole o unde lying, unde ec ed scena ios such as ca diac hype ophy and hy oid dys-
unc ion [12].
In he p esen s udy, cTnT aised in all pa icipan s a e exe cise, and peak ele a ions
a 3 h pos exe cise we e compa able among g oups. This is con a y o ou expec a ions,
since p e ious au ho s sugges ed ha he less ma u e myoca dium in he younge migh
Figu e 1.
Indi idual poin s o cTnT by g oup. Red ho izon al line and ed do s deno e he cu o
alue o myoca dial in a c ion (MI) o 13.5 ng/L and abo e alues, espec i ely.
4. Discussion
The pu pose o his s udy was o compa e he exe cise-induced elease o cTnT be-
ween adolescen s and adul s. Ou main inding was ha , al hough ha ing compa able
aining expe ience and baseline alues o cTnT, adul s exe cised a lowe absolu e and
ela i e in ensi y, bu p esen ed highe immedia e concen a ions o cTnT a e exe cise
han adolescen s. Howe e , peak concen a ions we e obse ed a 3 h pos exe cise in all
pa icipan s and we e compa able be ween g oups.
Re e ence alues o cTn seem o be lowe in he young, and his migh be explained
by a posi i e associa ion be ween age and he p e alence o ca dio ascula diseases [
4
,
11
].
Howe e , ou esul s did no suppo hose p e ious s a emen s since swimme s had
compa able basal concen a ions o cTnT. E en hough his s udy was limi ed by a small
sample size, i is no he i s esea ch inding no age-di e ences in appa en ly heal hy,
ained, young pa icipan s [
7
]. In e es ingly hough, al hough peak cTnT was ound
in all pa icipan s a 3 h pos exe cise, we de ec ed highe ele a ions immedia ely a e
exe cise in he adul s. Since peak ele a ions we e compa able among g oups, his sugges s
ha se ological cTnT ele a ions migh appea ea lie a e exe cise in adul s compa ed
wi h adolescen s.
I has been sugges ed ha highe concen a ions o pos -exe cise cTn in he olde may
ep esen myoca dial inju y because o unde lying, subclinical, ca diac pa hology [
11
].
Howe e , all pa icipan s in his s udy had no mal es ing ECG a he beginning o he
s udy. Fu he mo e, one yea a e he in e en ion, none o hem epo ed o ha e had
ca diac symp oms o e en s du ing his pe iod. Assuming ha ou pa icipan s we e
heal hy, hese e idences align wi h he heo y o ansien ele a ions o cTnT a e ex-
e cise being a physiological acu e esponse o exe cise a he han a sign o myoca dial
inju y [
3
]. Howe e , his s udy did no include o he examina ions o myoca dial heal h
such as echoca diog aphies o o he bioma ke assessmen s such as N- e minal p oho -
mone o b ain na iu e ic pep ide (NT-p oBNP), c ea ine kinase myoca dial band (CK-MB),
o c- eac i e p o ein (CRP). Due o his limi a ion, we canno be ce ain o disca d a pos-
sible ole o unde lying, unde ec ed scena ios such as ca diac hype ophy and hy oid
dys unc ion [12].
In he p esen s udy, cTnT aised in all pa icipan s a e exe cise, and peak ele a ions
a 3 h pos exe cise we e compa able among g oups. This is con a y o ou expec a ions,
since p e ious au ho s sugges ed ha he less ma u e myoca dium in he younge migh be
mo e suscep ible o exe cise-induced ele a ions o cTn [
8
,
9
]. In e es ingly hough, a ecen
In . J. En i on. Res. Public Heal h 2021,18, 1285 5 o 6
s udy epo ed highe exe cise-induced ele a ions o cTnT in la e pube y, sugges ing ha
his migh be explained by he highe ela i e in ensi ies du ing exe cise achie ed in his
g oup [
13
]. In line wi h his s udy, ou adolescen s g oup also achie ed highe ca diac
in ensi ies du ing he es . In spi e o ha , we ound no associa ion be ween exe cise
in ensi y and peak ele a ions o cTnT. This inding seems in e es ing, since we expec ed
pos -exe cise cTnT concen a ions o be di ec ly associa ed wi h exe cise in ensi y, as has
been epo ed in p e ious s udies [
4
]. Thus, ou esul s no only sugges ha adul s ele a e
cTn be o e adolescen s, bu also ha he associa ion be ween cTnT ele a ions and exe cise
in ensi y migh no depend on age.
Almos one-hal o he pa icipan s in his s udy (44%) exceeded he uppe e e ence
limi o cTnT in he hi d blood ex ac ion. P e ious s udies in ol ing simila assessmen s
and exe cise exposu es also ound high a es o posi i e de ec ion in bo h young and adul
ained pa icipan s [
4
,
6
–
8
,
13
]. This is pa icula ly ele an o he iage o a hle es who
de elop ches pain ha mimics ca diac inju y a e exe cise, and who migh ha e se um
cTn d awn in he EDs. Fo hese easons, u u e s udies should add ess he limi a ions
p esen in his esea ch, including a mo e exhaus i e clinical sc eening o he pa icipan s
in o de o disca d o iden i y a po en ial ole o unde lying pa hology.
Finally, in he au ho s’ opinion, he main s eng h o his s udy is ha ha we could
compa e he ele a ions o cTnT in a coho o ained swimme s ha allowed compa isons
be ween age g oups, and his made i possible o us o iden i y an ea lie ele a ion in he
adul s compa ed wi h he adolescen s. The main limi a ions in his s udy, by con as , ha e
been men ioned in he abo e pa ag aphs. We could no pe o m an exhaus i e ca diac
sc eening including echoca diog aphy, addi ional biochemical analyses, o assessmen s
o ma u a ional s a us, as has been done o men ioned in some p e ious
s udies [6,12,13]
.
Addi ionally, we did no pe o m cTnT measu emen s beyond he 3 h pos exe cise. Conse-
quen ly, he limi ed sampling poin s in ou design imply a po en ial unde -es ima ion e o
in he peak cTnT concen a ions, as has been p e iously sugges ed by o he s [14,15].
5. Conclusions
In conclusion, in his s udy we obse ed age di e ences in he immedia e ele a ion
o cTnT a e exe cise, bu no in i s peak ele a ions, a 3 h pos exe cise. Al hough
pa icipan s we e appa en ly heal hy based on es ing ECG and a 1 yea e m ollow-up,
u u e wo ks migh con inue his line o esea ch and explo e he associa ion be ween
immedia e ele a ions o cTnT, age, and heal h.
Au ho Con ibu ions:
Concep ualiza ion, R.C.-S., F.C. and J.R.-M.; Da a cu a ion, R.C.-S. and I.L.-L.;
Fo mal analysis, R.C.-S.; Funding acquisi ion, F.C. and J.R.-M.; In es iga ion, R.C.-S., I.L.-L., and
L.E.C.-G.; Me hodology, R.C.-S. and F.C.; P ojec adminis a ion, R.C.-S. and J.R.-M.; Resou ces,
R.C.-S., F.C. and I.L.-L.; So wa e, R.C.-S.; Supe ision, F.C. and J.R.-M.; Valida ion, R.C.-S. and
L.E.C.-G.; Visualiza ion, R.C.-S.; and W i ing— e iew and edi ing, R.C.-S., L.E.C.-G., F.C., and J.R.-M.
All au ho s ha e ead and ag eed o he published e sion o he manusc ip .
Funding:
This esea ch was unded by he Na ional Ins i u e o Physical Educa ion o Ca alonia,
g an numbe 2016-PINEF-00007 and Ins i u de Desen olupamen Social i Te i o ial (INDEST),
g an numbe 2018CRINDESTABC.
Ins i u ional Re iew Boa d S a emen :
The s udy was conduc ed acco ding o he guidelines o
he Decla a ion o Helsinki, and app o ed by he E hical Commi ee o Clinical Resea ch o Spo s
Adminis a ion o Ca alonia (02/2018/CEICGC).
In o med Consen S a emen :
In o med consen was ob ained om all subjec s in ol ed in he s udy.
Da a A ailabili y S a emen :
The da a p esen ed in his s udy a e a ailable on eques o he au ho s.
Some a iables a e es ic ed o p ese e he anonymi y o s udy pa icipan s.
Con lic s o In e es : The au ho s decla e no con lic o in e es .

In . J. En i on. Res. Public Heal h 2021,18, 1285 6 o 6
Re e ences
1.
Thygesen, K.; Alpe , J.S.; Ja e, A.S.; Chai man, B.R.; Bax, J.J.; Mo ow, D.A.; Whi e, H.D. Fou h Uni e sal De ini ion o
Myoca dial In a c ion (2018). J. Am. Coll. Ca diol. 2018,33, 2551–2567. [C ossRe ]
2.
Mai , J.; Lindahl, B.; Hamma s en, O.; Mülle , C.; Gianni sis, E.; Hube , K.; Möckel, M.; Plebani, M.; Thygesen, K.; Ja e, A.S.
How is Ca diac T oponin Released om Inju ed Myoca dium? Eu . Hea J. Acu e Ca dio asc. Ca e
2018
,7, 553–560. [C ossRe ]
[PubMed]
3.
Bake , P.; Leckie, T.; Ha ing on, D.; Richa dson, A. Exe cise-Induced Ca diac T oponin Ele a ion: An Upda e on he E idence,
Mechanism and Implica ions. In . J. Ca diol. Hea Vasc. 2019,22, 181–186. [C ossRe ] [PubMed]
4.
Ci e -Sas e, R.; Legaz-A ese, A.; Co bi, F.; Geo ge, K.; Nie, J.; Ca anza-Ga cía, L.E.; Re e e -Masià, J. Ca diac Bioma ke
Release A e Exe cise in Heal hy Child en and Adolescen s: A Sys ema ic Re iew and Me a-Analysis. Pedia . Exe c. Sci.
2019
,
31, 28–36. [C ossRe ] [PubMed]
5.
Klinkenbe g, L.J.J.; Luy en, P.; an de Linden, N.; U gel, K.; Snijde s, D.P.C.; Knacks ed , C.; Denne , R.; Kie selae , B.L.J.H.;
Mingels, A.M.A.; Ca dinaels, E.P.M.; e al. Ca diac T oponin T and I Release A e a 30-Km Run. Am. J. Ca diol.
2016
,118, 281–287.
[C ossRe ] [PubMed]
6.
Legaz-A ese, A.; Ca anza-Ga cía, L.E.; Na a o-O ocio, R.; Valadez-Li a, A.; Mayolas-Pi, C.; Munguía-Izquie do, D.; Re e e -
Masía, J.; Geo ge, K. Ca diac Bioma ke Release a e Endu ance Exe cise in Male and Female Adul s and Adolescen s. J. Pedia .
2017,191, 96–102. [C ossRe ] [PubMed]
7.
López-La al, I.; Legaz-A ese, A.; Geo ge, K.; Se e o-Galindo, O.; González-Ra e, J.M.; Re e e -Masia, J.; Munguía-Izquie do,
D. Ca diac T oponin I Release a e a Baske ball Ma ch in Eli e, Ama eu and Junio Playe s. Clin. Chem. Lab. Med. CCLM
2016
,
54, 333–338. [C ossRe ] [PubMed]
8.
Tian, Y.; Nie, J.; Huang, C.; Geo ge, K.P. The Kine ics o Highly Sensi i e Ca diac T oponin T Release a e P olonged T eadmill
Exe cise in Adolescen and Adul A hle es. J. Appl. Physiol. 2012,113, 418–425. [C ossRe ] [PubMed]
9.
Fu, F.; Nie, J.; Tong, T. Se um Ca diac T oponin T in Adolescen Runne s: E ec s o Exe cise In ensi y and Du a ion. In . J. Spo s
Med. 2009,30, 168–172. [C ossRe ] [PubMed]
10.
Aenge ae en, V.L.; Hopman, M.T.E.; Thompson, P.D.; Bakke , E.A.; Geo ge, K.P.; Thijssen, D.H.J.; Eijs ogels, T.M.H. Exe cise-
Induced Ca diac T oponin I Inc ease and Inciden Mo ali y and Ca dio ascula E en s. Ci cula ion
2019
,140, 804–814. [C ossRe ]
[PubMed]
11.
Gianni sis, E.; Ku z, K.; Halle maye , K.; Ja ausch, J.; Ja e, A.S.; Ka us, H.A. Analy ical Valida ion o a High-Sensi i i y Ca diac
T oponin T Assay. Clin. Chem. 2010,56, 254–261. [C ossRe ] [PubMed]
12.
˙
Zeb owska, A.; Wa´skiewicz, Z.; Nikolaidis, P.T.; Mikołajczyk, R.; Kawecki, D.; Rosemann, T.; Knech le, B. Acu e Responses o
No el Ca diac Bioma ke s o a 24-h Ul a-Ma a hon. J. Clin. Med. 2019,8, 57. [C ossRe ] [PubMed]
13.
Ci e -Sas e, R.; Legaz-A ese, A.; Co bi, F.; López-La al, I.; Geo ge, K.; Re e e -Masia, J. In luence o Ma u a ional S a us in he
Exe cise-Induced Release o Ca diac T oponin T in Heal hy Young Swimme s. J. Sci. Med. Spo
2020
,24, 116–121. [C ossRe ]
[PubMed]
14.
Nie, J.; Geo ge, K.P.; Tong, T.K.; Gaze, D.; Tian, Y.; Lin, H.; Shi, Q. The In luence o a Hal -Ma a hon Race upon Ca diac T oponin
T Release in Adolescen Runne s. Cu . Med. Chem. 2011,18, 3452–3456. [C ossRe ] [PubMed]
15.
Nie, J.; Tong, T.K.; Shi, Q.; Lin, H.; Zhao, J.; Tian, Y. Se um Ca diac T oponin Response in Adolescen s Playing Baske ball. In . J.
Spo s Med. 2008,29, 449–452. [C ossRe ] [PubMed]