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High-Sensitivity Cardiac Troponin T and Cognitive Function Over 12 Months After Stroke-Results of the DEMDAS Study
Regina von Rennenberg1,2,3, Christian H Nolte1,2,3,4,5, Thomas G Liman1,2,3,6
1Department of Neurology (Klinik und Hochschulambulanz für Neurologie) Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany.
Insights
Subclinical myocardial injury, indicated by high-sensitivity cardiac troponin T (hs-cTnT) levels, is linked to cognitive decline and cerebral small vessel disease (SVD) in stroke patients. This study reveals hs-cTnT is associated with SVD burden and impaired attention and executive function post-stroke.
Area of Science:
- Cardiology
- Neurology
- Neuroimaging
Background:
- Subclinical myocardial injury, measured by high-sensitivity cardiac troponin (hs-cTn) levels, is linked to cognitive impairment and cerebral small vessel disease (SVD) in general populations.
- The association between hs-cTn and domain-specific cognitive decline or SVD burden in stroke patients is not well understood.
Purpose of the Study:
- To investigate the relationship between hs-cTnT levels and cognitive decline across different domains in patients following an acute stroke.
- To examine the association between hs-cTnT levels and the burden of SVD markers in stroke survivors.
Main Methods:
- Analysis of data from the prospective multicenter DEMDAS study, including 385 patients for cognitive assessment and 466 for SVD marker analysis.
- Neuropsychological testing at 6 and 12 months post-stroke, assessing 5 cognitive domains.
- Cranial MRI to evaluate SVD markers (lacunes, microbleeds, white matter hyperintensities, enlarged perivascular spaces) and calculate a global SVD score.
Main Results:
- Higher hs-cTnT levels were negatively associated with attention up to 12 months and executive function at 12 months post-stroke, after adjusting for confounders.
- Elevated hs-cTnT was significantly associated with a higher global SVD score, as well as increased white matter hyperintensities and lacunes.
- Associations were adjusted for demographic factors, cardiovascular risk factors, and baseline cognitive status.
Conclusions:
- In patients with stroke, hs-cTnT levels are associated with an increased burden of SVD markers.
- Higher hs-cTnT is linked to cognitive impairment in domains commonly affected by vascular cognitive impairment, such as attention and executive function.
Background:
Subclinical myocardial injury in form of hs-cTn (high-sensitivity cardiac troponin) levels has been associated with cognitive impairment and imaging markers of cerebral small vessel disease (SVD) in population-based and cardiovascular cohorts. Whether hs-cTn is associated with domain-specific cognitive decline and SVD burden in patients with stroke remains unknown.
Methods And Results:
We analyzed patients with acute stroke without premorbid dementia from the prospective multicenter DEMDAS (DZNE [German Center for Neurodegenerative Disease]-Mechanisms of Dementia after Stroke) study. Patients underwent neuropsychological testing 6 and 12 months after the index event. Test results were classified into 5 cognitive domains (language, memory, executive function, attention, and visuospatial function). SVD markers (lacunes, cerebral microbleeds, white matter hyperintensities, and enlarged perivascular spaces) were assessed on cranial magnetic resonance imaging to constitute a global SVD score. We examined the association between hs-cTnT (hs-cTn T levels) and cognitive domains as well as the global SVD score and individual SVD markers, respectively. Measurement of cognitive and SVD-marker analyses were performed in 385 and 466 patients with available hs-cTnT levels, respectively. In analyses adjusted for demographic characteristics, cardiovascular risk factors, and cognitive status at baseline, higher hs-cTnT was negatively associated with the cognitive domains "attention" up to 12 months of follow-up (beta-coefficient, -0.273 [95% CI, -0.436 to -0.109]) and "executive function" after 12 months. Higher hs-cTnT was associated with the global SVD score (adjusted odds ratio, 1.95 [95% CI, 1.27-3.00]) and the white matter hyperintensities and lacune subscores.
Conclusions:
In patients with stroke, hs-cTnT is associated with a higher burden of SVD markers and cognitive function in domains linked to vascular cognitive impairment.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01334749.
