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Published on: January 28, 2020
Cardiac biomarkers are associated with increased risks of adverse clinical outcomes after ischemic stroke
Xinyue Chang1, Shiliang Xia2, Yang Liu2,3
1Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-Communicable Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, Jiangsu Province, China.
Insights
Elevated cardiac biomarkers like lactate dehydrogenase (LDH), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity cardiac troponin T (hs-cTnT) are linked to worse outcomes after ischemic stroke. These markers can help predict stroke severity and functional recovery.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Cardiac dysfunction is suspected to impact recovery post-ischemic stroke.
- The prognostic significance of cardiac biomarkers in ischemic stroke patients is not well-established.
Purpose of the Study:
- To prospectively investigate the association between serum lactate dehydrogenase (LDH), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), and plasma high-sensitivity cardiac troponin T (hs-cTnT) with adverse clinical outcomes following ischemic stroke.
- To evaluate the prognostic value of these cardiac biomarkers in a large cohort of ischemic stroke patients.
Main Methods:
- Serum LDH, plasma NT-proBNP, and plasma hs-cTnT levels were measured at baseline in 5056 ischemic stroke patients.
- Patients were followed up for 3 months to assess the composite outcome of death and major disability (modified Rankin Scale score ≥ 3).
- Statistical analyses included multivariable-adjusted models and spline regression to assess associations and linearity.
Main Results:
- Elevated baseline levels of LDH, NT-proBNP, and hs-cTnT were significantly associated with an increased risk of adverse outcomes at 3 months post-stroke.
- The highest quartiles of LDH, NT-proBNP, and hs-cTnT showed odds ratios of 1.37, 2.51, and 2.24, respectively, for the primary outcome.
- A combined cardiac biomarker score also demonstrated a strong independent association with adverse outcomes, and improved risk reclassification when added to conventional risk factors.
Conclusions:
- Serum LDH, plasma NT-proBNP, and plasma hs-cTnT are independently associated with adverse clinical outcomes in ischemic stroke patients.
- These cardiac biomarkers show potential as prognostic indicators for predicting outcomes after ischemic stroke.
- The findings support the integration of cardiac biomarker assessment in the management and risk stratification of ischemic stroke.
Background:
Impaired cardiac function was suggested to be implicated in the functional recovery after ischemic stroke, but the prognostic value of cardiac biomarkers among ischemic stroke patients remains unclear. We aimed to prospectively explore the associations of serum lactate dehydrogenase (LDH), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), and plasma high-sensitivity cardiac troponin T (hs-cTnT) with adverse clinical outcomes after ischemic stroke in a large-scale cohort study.
Methods:
We measured serum LDH, plasma NT-proBNP, and plasma hs-cTnT levels at baseline among 5056 ischemic stroke patients from the Minhang Stroke Cohort study. All patients were followed up at 3 months after ischemic stroke onset. The primary outcome was composite outcome of death and major disability (modified Rankin Scale [mRS] score ≥ 3) at 3 months after stroke onset, and secondary outcomes included death and ordered 7-level categorical score of the mRS.
Results:
During 3 months of follow-up, 1584 patients developed the primary outcome. Baseline serum LDH, plasma NT-proBNP, and plasma hs-cTnT were positively associated with the risk of adverse outcomes after ischemic stroke. The multivariable-adjusted odds ratios of primary outcome for the highest versus lowest quartile of LDH, NT-proBNP, and hs-cTnT were 1.37 (95% CI 1.13-1.66; Ptrend = 0.001), 2.51 (95% CI, 2.00-3.16; Ptrend < 0.001), and 2.24 (95% CI 1.77-2.83; Ptrend < 0.001), respectively. Each SD increase of log-transformed cardiac biomarker score was associated with a 49% (95% CI 37-62%; P < 0.001) increased risk of primary outcome. Multivariable-adjusted spline regression analyses showed linear relationships between cardiac biomarkers and the risk of primary outcome (all P for linearity < 0.001). Moreover, adding LDH, NT-proBNP, hs-cTnT, or cardiac biomarker score to conventional risk factors significantly improved the risk reclassification of primary outcome after ischemic stroke (all P < 0.05).
Conclusion:
High LDH, NT-proBNP, hs-cTnT, and cardiac biomarker score were independently associated with increased risks of adverse clinical outcomes among ischemic stroke patients, suggesting that cardiac biomarkers might be potential prognostic biomarkers for ischemic stroke.
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