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To the Editor
Recently Cramer et al 1 demonstrated very important observation on troponin level increase after exercise in patients with hypertrophic cardiomyopathy (HCM). Several concerns regarding to methodology of their study should be explained. Authors decided to perform only one measurement of troponin level at 6 hours after end of exercise. In our opinion, sampling after 6, 12, 18 and 24 hours after exercise provide more adequate profile of troponin level and allow to monitor possible postexercise ischaemia. Furthermore, data on prevalence of silent myocardial ischaemia (only troponin increase) should be provided. In our study2 painless ischemia detected by troponin measurement after normal daily physical activity was present in 25% of HCM patients. In another study,3 among HCM patients monitored by Holter ECG during normal daily physical activity, maximum heart rate was higher in the troponin-positive group as compared with troponin-negative group (139±9 vs 125±8 (bpm), p<0.05). Similar association was observed in current exercise study.1 However, peak exercise left ventricular outflow tract gradient was not evaluated1 despite previously reported association with elevated troponin level.4
To provide more individualised and comprehensive recommendations with regard to exercise intensity in HCM, some additional study should be performed with improved methodology including described above criteria.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.