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Association of Cardiac Biomarkers in Combination With Cognitive Impairment After Acute Ischemic Stroke
Pinni Yang1, Shuyao Wang2, Chongke Zhong1
1Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China.
Insights
Elevated cardiac biomarkers like sST2, GDF-15, and NT-proBNP increase the risk of poststroke cognitive impairment. Combining these biomarkers improves prediction of cognitive decline after stroke.
Area of Science:
- Neurology
- Cardiology
- Biomarker Research
Background:
- Poststroke cognitive impairment is a significant global health issue.
- Identifying predictive biomarkers is crucial for managing stroke complications.
Purpose of the Study:
- To evaluate the association between three cardiac biomarkers and poststroke cognitive impairment.
- To assess the prognostic significance of these biomarkers in predicting cognitive decline.
Main Methods:
- Prospective study of 566 ischemic stroke patients.
- Measured cardiac biomarkers: sST2, GDF-15, and NT-proBNP.
- Cognitive impairment assessed at 3 months using MMSE (<27) and MoCA (<25).
Main Results:
- Increased odds of cognitive impairment correlated with a higher number of elevated cardiac biomarkers (sST2, GDF-15, NT-proBNP; Ptrend<0.001).
- ≥2 elevated biomarkers associated with significantly higher odds of cognitive impairment (ORs 2.45 for MMSE, 1.86 for MoCA).
- Combined biomarkers improved risk prediction for cognitive impairment (NRI=34.99%, P<0.001).
Conclusions:
- Elevated levels of novel cardiac biomarkers are linked to increased odds of poststroke cognitive impairment.
- A combination of sST2, GDF-15, and NT-proBNP may enhance the prediction of cognitive impairment after stroke.
Background:
Poststroke cognitive impairment is a severe and common clinical complication that constitutes a substantial global health burden. We aimed to evaluate the association of 3 cardiac biomarkers in combination with poststroke cognitive impairment and their prognostic significance.
Methods And Results:
This prospective study included 566 patients with ischemic stroke. Cardiac biomarkers, including sST2 (soluble suppression of tumorigenicity-2 receptor), GDF-15 (growth differentiation factor-15), and NT-proBNP (N-terminal pro-B-type natriuretic peptide), were measured. Cognitive impairment was defined as a Mini-Mental State Examination score of <27 or a Montreal Cognitive Assessment score of <25 at 3 months after ischemic stroke. Odds of cognitive impairment 3 months after ischemic stroke increased with the number of elevated cardiac biomarkers (sST2, GDF-15, and NT-proBNP; Ptrend<0.001). The multivariable adjusted odds ratios (95% CIs) of cognitive impairment defined by the Mini-Mental State Examination and Montreal Cognitive Assessment were 2.45 (1.48-4.07) and 1.86 (1.10-3.14) for the participants with ≥2 elevated cardiac biomarkers, respectively, compared with those without any elevated cardiac biomarker. Additionally, higher cardiac biomarker scores were associated with an increased risk of cognitive impairment (Ptrend<0.05). Simultaneously adding all 3 cardiac biomarkers to the basic model with traditional risk factors significantly improved the risk prediction of Mini-Mental State Examination-defined cognitive impairment (net reclassification improvement=34.99%, P<0.001; integrated discrimination index=2.67%, P<0.001). Similar findings were observed using the Montreal Cognitive Assessment scores.
Conclusions:
An increased number of elevated novel cardiac biomarkers were associated with an increased odds of poststroke cognitive impairment, suggesting that a combination of these cardiac biomarkers may improve the risk prediction of cognitive impairment.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.
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