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Predictors and Implications of Myocardial Injury in Intracerebral Hemorrhage

Felix Hess1, Julian McGinnis2,3, Enayatullah Baki

  • 1Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. felixhans.hess@tum.de.

Clinical Neuroradiology
|January 30, 2025
PubMed

Insights

Myocardial injury is common in patients with intracerebral hemorrhage (ICH), leading to worse outcomes. Acute myocardial injury, linked to midline shift in brain scans, increases the risk of cardiac events.

Area of Science:

  • Cardiology
  • Neurology
  • Stroke Medicine

Background:

  • Myocardial injury, indicated by elevated high-sensitive cardiac Troponin (hs-cTnT), is a common complication following ischemic stroke.
  • Limited data exists on myocardial injury occurrence in patients with intracerebral hemorrhage (ICH).

Purpose of the Study:

  • To determine the frequency, predictors, and implications of myocardial injury in patients with ICH.
  • To investigate the association between acute myocardial injury and brain imaging findings, including midline shift.
  • To explore the relationship between acute myocardial injury and pre-existing cardiac conditions or adverse cardiac events.

Main Methods:

  • Retrospective analysis of 322 ICH patients.
  • Myocardial injury defined by hs-cTnT elevation (>99th percentile, 14 ng/L).
  • Acute myocardial injury defined by >50% hs-cTnT change within 24h or initial hs-cTnT >52 ng/L.
  • 3D brain scans assessed for ICH using visual inspection and a deep learning algorithm.
  • Statistical analysis included multiple regression models and Voxel-based Lesion-Symptom Mapping (VLSM).

Main Results:

  • Myocardial injury was present in 63.0% of ICH patients, associated with more severe strokes and worse in-hospital outcomes.
  • Acute myocardial injury occurred in 24.5% of patients.
  • Midline shift on brain scans was the only imaging finding associated with and predictive of acute myocardial injury (OR 3.29).
  • Acute myocardial injury was not correlated with pre-existing cardiac diseases but was linked to a higher frequency of adverse cardiac events (11.4% vs. 4.1%).

Conclusions:

  • Myocardial injury is frequent in ICH patients and associated with poor outcomes.
  • Acute myocardial injury in ICH is primarily related to the space-occupying effects of the hemorrhage (midline shift) rather than pre-existing cardiac conditions.
  • Despite not being dependent on premorbid cardiac status, acute myocardial injury in ICH patients signifies an increased risk of adverse cardiac events.
Abstract

Keywords:
Deep learningIntracerebral hemorrhageStrokeTroponin

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