Neutrophil-to-lymphocyte ratio and exercise intensity are associated with cardiac-troponin levels after prolonged cycling: the Indonesian North Coast and Tour de Borobudur 2017 Troponin Study
The mechanism of cardiac-troponin elevation after exercise remains unclear. Studies have reported that leucocyte ratios are related to coronary artery disease. The present study explored the relationship between leucocyte ratios, exercise intensity, and post-exercise cardiac-troponin I (cTnI) levels.
Ninety-two participants in a long-distance cycling tour were included in this study. Baseline and post-exercise blood samples were collected to determine cTnI concentrations. Biochemical parameters and leucocyte ratios were measured at baseline. Exercise intensity was examined by recording the heart rate (HR). Exercise intensity was determined as the percentage of peak HR to maximal predicted HR. Based on clinical cutoff points of the cTnI assay, cTnI levels were defined as < 10 ng/mL and ≥ 10 ng/mL.
Eighty-eight participants completed the cycling tour after a median time of 7.3 h, at a median intensity of 81.8% of maximal HR. cTnI concentrations increased from 5.2 ± 9.83 ng/mL at baseline to 13.6 ± 36.12 ng/mL post-exercise, with 31.8% of the study population having cTnI ≥ 10 ng/mL. Neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio, recovery HR, mean and peak HR, and exercise intensity were associated with post-exercise cTnI levels in bivariate analysis. After adjustment for potential confounders, only NLR and exercise intensity were significantly related to post-exercise cTnI levels in the multivariable model.
NLR and exercise intensity are significantly associated with post-exercise cTnI levels, suggesting that inflammatory factors may play a role in the magnitude of exercise-induced cTnI release beyond exercise intensity.
KeywordsCardiac stress Lymphocyte Neutrophil Physical-exertion Troponin
Coronary artery disease
North Sea Race Endurance Exercise study
Sudden cardiac death
Tour de Borobudur
The study was funded by the Directorate of Research and Public Service, Ministry of Research, Technology and Higher Education of the Republic of Indonesia (Grant number DIPA 042.06.1.401516.)
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Ethical Committee of the Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital, Semarang, Indonesia; approval number 607/EC/FK-RSDK/X/2017) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all individual participants included in the study.
- 10.Skadberg Ø, Kleiven Ø, Bjørkavoll-Bergseth M et al (2017) Highly increased troponin I levels following high-intensity endurance cycling may detect subclinical coronary artery disease in presumably healthy leisure sport cyclists: the north sea race endurance exercise study (NEEDED) 2013. Eur J Prev Cardiol 24:885–894CrossRefGoogle Scholar
- 19.Fernando ML, Slambanan S, Malar J (2015) Neutrophil to lymphocyte ratio as an indicator of presence of coronary artery disease in diabetic patients. Int J Clin Biochem Res 2:143–147Google Scholar
- 29.Nunes-Silva A (2014) Exercise-induced inflammatory response: to use or not use anti-inflammatory medication. J Sports Med Doping Stud 4:142Google Scholar
- 32.Oncel RC, Ucar M, Karakas MS, Akdemir B, Yanikoglu A, Gulcan AR, Altekin RE, Demir I (2015) Relation of neutrophil-to-lymphocyte ratio with GRACE risk score to in-hospital cardiac events in patients with ST-segment elevated myocardial infarction. Clin Appl Thromb Hemost 21:383–388CrossRefGoogle Scholar