Frequency, determinants and outcome of elevated troponin in acute ischemic stroke patients
Jan F Scheitz1, Matthias Endres, Hans-Christian Mochmann
1Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany. jan-friedrich.scheitz@charite.de
Insights
Cardiac troponin T (cTnT) elevation occurs in 14% of acute ischemic stroke patients, predicting poor outcomes and mortality. Insular cortex strokes particularly increase myocardial injury risk, warranting cardiac monitoring.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Myocardial injury, indicated by elevated cardiac troponins (cTnT), is observed in acute ischemic stroke patients.
- The frequency, determinants, and prognostic value of cTnT elevation in stroke are not fully understood.
Purpose of the Study:
- To determine the frequency, identify predictors, and assess the prognostic significance of elevated cTnT in acute ischemic stroke patients.
Main Methods:
- A retrospective analysis of 715 consecutive ischemic stroke patients admitted within 72 hours of symptom onset.
- Multivariable logistic regression was used to identify determinants of cTnT elevation and factors associated with outcomes.
Main Results:
- cTnT elevation occurred in 14% of patients.
- Predictors included stroke severity, renal insufficiency, coronary artery disease, hypercholesterolemia, and insular cortex involvement.
- Elevated cTnT independently predicted unfavorable short-term outcome and in-hospital mortality.
Conclusions:
- Elevated cTnT is common in acute ischemic stroke and linked to adverse outcomes.
- Patients with insular cortex strokes are at higher risk for myocardial injury, necessitating cardiac monitoring.
Background:
Myocardial injury indicated by elevation of cardiac troponins (cTnT) can be observed in acute ischemic stroke patients. Frequency, determinants and prognostic value are still unsettled.
Methods:
We performed a retrospective analysis including all consecutive ischemic stroke patients admitted to our stroke unit within 72 h after symptom onset in a one-year period. Multivariable logistic regression analyses were conducted to identify determinants of cTnT elevation and to detect factors independently associated with unfavorable short-term outcome (modified Rankin scale >2), major neurologic improvement (improvement of NIHSS> =8 or NIHSS 0-1) and in-hospital mortality.
Results:
Admission cTnT levels were measured in 715 ischemic stroke patients. Frequency of cTnT elevation was 14% (n=103). Factors independently associated with increased cTnT were higher stroke severity (p=0.04), renal insufficiency (p<0.001), pre-existing coronary artery disease (p=0.03), hypercholesterolemia (p=0.02) and insular cortex involvement (p<0.001). After exclusion of patients with renal insufficiency and coronary artery disease frequency of cTnT elevation was 10% (n=44) and only insular cortex involvement remained significantly associated. Increased cTnT on admission was an independent predictor of unfavorable outcome (adjusted odds ratio 2.65 [95% confidence interval 1.29-5.46]) and in-hospital mortality (4.51 [1.93-10.57]). There was a trend towards a negative association of cTnT elevation with major neurologic improvement (0.54 [0.27-1.07]).
Conclusions:
Elevation of cTnT occurs in every seventh patient with acute ischemic stroke and is independently associated with poor short-term outcome and mortality. Patients with strokes affecting the insular cortex are particularly prone to myocardial injury justifying intensive cardiac monitoring.
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