Early Elevated Troponin Levels After Ischemic Stroke Suggests a Cardioembolic Source
Shadi Yaghi1, Andrew D Chang2, Brittany A Ricci2
1From the Department of Neurology (S.Y., A.D.C., B.A.R., M.H., P.N., K.D., B.M., S.M.C., T.M.B., M.R., K.L.F.), Department of Neurosurgery (M.V.J., R.A.M.), Department of Diagnostic Imaging (M.V.J., R.A.M.), Department of Internal Medicine, Division of Cardiovascular Medicine (C.S., E.M.), and Department of Emergency Medicine (M.S., T.E.M.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Neurology (A.E.M., M.P.L., H.K.) and Feil Family Brain and Mind Research Institute (A.E.M., M.P.L., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology, College of Physicians and Surgeons (M.S.V.E.) and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY. shadiyaghi@yahoo.com.
Insights
Elevated troponin levels in acute ischemic stroke patients are linked to cardioembolic stroke subtypes. This finding may help identify stroke origins and guide future prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Elevated cardiac troponin indicates cardiac disease and is linked to embolic stroke risk.
- Cardiac troponin's role in acute ischemic stroke subtypes requires further investigation.
Purpose of the Study:
- To determine if early elevated troponin levels are more prevalent in embolic stroke subtypes compared to non-embolic subtypes.
- To investigate the association between troponin positivity and specific embolic stroke classifications.
Main Methods:
- Analysis of a prospective ischemic stroke database over 18 months.
- Definition of positive troponin as ≥0.1 ng/mL and intermediate as ≥0.06 ng/mL and <0.1 ng/mL.
- Use of unadjusted and adjusted regression models, controlling for demographics, clinical characteristics, cardiac variables, and infarct location.
Main Results:
- 10.0% of 1129 patients had positive troponin levels.
- Troponin positivity was significantly associated with embolic stroke of unknown source (aOR, 4.46; P=0.003).
- Troponin positivity was also significantly associated with cardioembolic stroke (OR, 5.00; P=0.002).
Conclusions:
- Early positive troponin after ischemic stroke may independently indicate a cardiac embolic source.
- Further research with high-sensitivity troponin assays is needed.
- Optimal secondary prevention strategies for patients with embolic stroke and positive troponin require testing.
Background And Purpose:
Elevated cardiac troponin is a marker of cardiac disease and has been recently shown to be associated with embolic stroke risk. We hypothesize that early elevated troponin levels in the acute stroke setting are more prevalent in patients with embolic stroke subtypes (cardioembolic and embolic stroke of unknown source) as opposed to noncardioembolic subtypes (large-vessel disease, small-vessel disease, and other).
Methods:
We abstracted data from our prospective ischemic stroke database and included all patients with ischemic stroke during an 18-month period. Per our laboratory, we defined positive troponin as ≥0.1 ng/mL and intermediate as ≥0.06 ng/mL and <0.1 ng/mL. Unadjusted and adjusted regression models were built to determine the association between stroke subtype (embolic stroke of unknown source and cardioembolic subtypes) and positive and intermediate troponin levels, adjusting for key confounders, including demographics (age and sex), clinical characteristics (hypertension, hyperlipidemia, diabetes mellitus, renal function, coronary heart disease, congestive heart failure, current smoking, and National Institutes of Health Stroke Scale score), cardiac variables (left atrial diameter, wall-motion abnormalities, ejection fraction, and PR interval on ECG), and insular involvement of infarct.
Results:
We identified 1234 patients, of whom 1129 had admission troponin levels available; 10.0% (113/1129) of these had a positive troponin. In fully adjusted models, there was an association between troponin positivity and embolic stroke of unknown source subtype (adjusted odds ratio, 4.46; 95% confidence interval, 1.03-7.97; P=0.003) and cardioembolic stroke subtype (odds ratio, 5.00; 95% confidence interval, 1.83-13.63; P=0.002).
Conclusions:
We found that early positive troponin after ischemic stroke may be independently associated with a cardiac embolic source. Future studies are needed to confirm our findings using high-sensitivity troponin assays and to test optimal secondary prevention strategies in patients with embolic stroke of unknown source and positive troponin.
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