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[Myocardial injury in acute stroke assessed by troponin I]
M Troøyen1, B Indredavik, O Rossvoll
1Det medisinske fakultet Norges teknisk-naturvitenskapelige universitet 7489 Trondheim.
Insights
Many acute stroke patients experience myocardial injury, indicated by elevated cardiac troponin I levels. This cardiac damage is associated with poorer neurological function and higher rates of hospital discharge to nursing homes.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Context:
- Acute cerebrovascular events, both ischemic and hemorrhagic, can lead to myocardial damage.
- Cardiac troponin I is a highly sensitive and specific biomarker for cardiac cell injury.
Purpose:
- To measure troponin I levels in acute stroke patients to assess the incidence of myocardial injury.
- To investigate the correlation between myocardial injury and stroke characteristics, patient history, and outcomes.
Summary:
- Troponin I was measured in 149 acute stroke patients. 27% had elevated troponin I (≥0.4 µg/L), indicating myocardial injury, with 6.7% exceeding 2.0 µg/L.
- Patients with myocardial injury showed higher CK-MB, more frequent ischemic ECG findings, a history of TIA and heart failure, and a higher prevalence of atrial fibrillation.
- Elevated troponin I correlated with embolic infarctions, abnormal CRP levels, lower functional and neurological scores, and increased discharge to nursing homes.
Impact:
- This study highlights the significant co-occurrence of myocardial injury in acute stroke patients.
- Elevated troponin I serves as a critical indicator of cardiac complications post-stroke, impacting patient prognosis and care planning.
Background:
Acute ischaemic or haemorrhagic cerebrovascular events may produce myocardial damage. Cardiac troponin I is an indicator of cardiac cell injury with very high sensitivity and specificity.
Material And Methods:
We measured troponin I in 149 acute stroke patients admitted to the stroke unit of Trondheim University Hospital, Norway, in January to June 1999.
Results:
40 patients (27%) had troponin I values at 0.4 microgram/l or higher, indicating myocardial injury. 10 patients (6.7%) had troponin I values above 2.0 micrograms/l. Similarly, the mean value of CK-MB vas higher in the patients with myocardial injury, and these patients had more often ECG findings suggesting myocardial ischaemia. Patients with myocardial injury had a higher rate of previous TIA and heart failure. ECG showed atrial fibrillation in 13 of 39 patients with myocardial damage. Patients with detectable levels of troponin I had more embolic brain infarctions than thrombotic brain infarctions. Patients with myocardial injury did more often have abnormal values of CRP. 9 of 10 patients with troponin I-values above 2.0 micrograms/l had abnormal CRP values. No differences in glycosylated haemoglobin, cholesterol, heart rate, blood pressure or body temperature were found. Patients with the highest troponin I values had lower systolic blood pressure, and a higher heart rate, but these differences were not statistically significant. Patients with troponin I values above 2.0 micrograms/l had lower functional and neurological scores at admittance. Patients with myocardial injury were more often discharged to nursing homes.
Interpretation:
Many patients with an acute stroke have at the same time a myocardial injury, determined by elevated troponin I values.