Multiple Cardiac Biomarkers and Long-Term Neurological Deficits Trajectory After Ischemic Stroke

The dynamic changes of neurological function frequently occur after ischemic stroke, while the underlying mechanisms remain unclear. Given cardiac pathologies from heart-brain axis may contribute to neurological decline, we aimed to investigate associations between cardiac biomarkers and long-term neurological deficits (ND) trajectory after ischemic stroke.

We derived data from China Antihypertensive Trial in Acute Ischemic Stroke, circulating NT-proBNP (N-terminal pro-B-type natriuretic peptide), sST2 (soluble ST2), and GDF-15 (growth differentiation factor 15) concentrations were measured. We applied group-based trajectory modeling to identify ND trajectories using National Institutes of Health Stroke Scale scores measured at admission, 14 days/hospital discharge, and 3-month, 12-month, and 24-month follow-up visits.

We identified 3 ND trajectories: mild, moderate, and persistent-severe. Compared with the lowest tertile, the odds ratios for the highest tertiles of NT-proBNP, sST2, and GDF-15 for persistent-severe ND trajectory were 2.20 (95% CI, 1.61-2.99), 3.52 (95% CI, 2.58-4.82), and 2.09 (95% CI, 1.54-2.84), respectively. Patients with ≥2 elevated biomarkers had higher risks of moderate ND and persistent-severe ND trajectories (both P<0.05). Because National Institutes of Health Stroke Scale scores of moderate and mild ND trajectories remained <5 after discharge, when we merged them into a "minor stroke" group, NT-proBNP, sST2, and GDF-15 were still associated with persistent-severe stroke (versus minor stroke). Simultaneously adding 3 biomarkers to the conventional factors model provided significant incremental value for the risk stratification of persistent-severe stroke (net reclassification improvement ranging from 40.5% to 58.1%, all P<0.05).

Cardiac biomarkers were associated with long-term moderate ND and persistent-severe ND trajectories after ischemic stroke.