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Cerebral venous thrombosis: Associations between disease severity and cardiac markers
Michelle C Johansen1, Rebecca F Gottesman1, Victor C Urrutia1
1Department of Neurology, the Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Cardiac troponin (cTn) elevation is linked to cerebral venous thrombosis (CVT) severity. Increased cTn levels in CVT patients may indicate poorer outcomes, warranting further research into this association.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Elevated plasma cardiac troponin (cTn) is observed in acute stroke and intracranial hemorrhage, often indicating a poor prognosis.
- Cerebral venous thrombosis (CVT) can cause venous stasis and cardiac stress, necessitating an evaluation of cTn levels in affected patients.
Purpose of the Study:
- To investigate the association between the severity of cerebral venous thrombosis (CVT) and the elevation of cardiac troponin (cTn).
Main Methods:
- A retrospective study of inpatients diagnosed with CVT between 2005 and 2015.
- Analysis of electrocardiogram (ECG) abnormalities and cTn levels (>0.06 ng/mL) in relation to CVT location and severity.
- Regression models adjusted for age, sex, and hypertension.
Main Results:
- Of 53 CVT patients included, 41% exhibited cTn elevation.
- Each additional thrombosed vein increased the odds of cTn elevation (adjusted OR 2.79).
- Deep venous involvement and venous infarction were significantly associated with higher cTn levels.
Conclusions:
- CVT severity markers correlate with increased odds of cTn elevation.
- Further research is required to understand the causal relationship and clinical significance of cTn elevation in CVT.
Background:
Plasma cardiac troponin (cTn) elevation occurs in acute ischemic stroke and intracranial hemorrhage and can suggest a poor prognosis. Because acute cerebral venous thrombosis (CVT) might lead to venous stasis, which could result in cardiac stress, it is important to evaluate whether cTn elevation occurs in patients with CVT.
Methods:
Inpatients at Johns Hopkins Hospital from 2005 to 2015 meeting the following criteria were included: CVT (ICD-9 codes with radiologic confirmation) and available admission electrocardiogram (ECG) and cTn level. In regression models, presence of ECG abnormalities and cTn elevation (>0.06 ng/mL) were evaluated as dependent variables in separate models, with location and severity of CVT involvement as independent variables, adjusted for age, sex, and hypertension.
Results:
Of 81 patients with CVST, 53 (66%) met the inclusion criteria. Participants were, on average, aged 42 years, white (71%), and female (66%). The left transverse sinus was most commonly thrombosed (47%), with 66% having >2 veins thrombosed. Twenty-two (41%) had cTn elevation. Odds of cTn elevation increased per each additional vein thrombosed (adjusted OR 2.79, 95% CI [1.08-7.23]). Of those with deep venous involvement, 37.5% had cTn elevation compared with 4.4% without deep clots (p = 0.02). Venous infarction (n = 15) was associated with a higher mean cTn (0.14 vs 0.02 ng/mL, p = 0.009) and was predictive of a higher cTn in adjusted models (β = 0.15, 95% CI [0.06-0.25]).
Conclusions:
In this single-center cohort study, markers of CVT severity were associated with increased odds of cTn elevation; further investigation is needed to elucidate causality and significance.
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