Association of Elevated High Sensitivity Cardiac Troponin T(hs-cTnT) Levels with Hemorrhagic Transformation and 3-Month Mortality in Acute Ischemic Stroke Patients with Rheumatic Heart Disease in China.

Wendan Tao,Junfeng Liu,Yao Xiong,Zilong Hao,Deren Wang,Firas H Kobeissy,Ming Liu,Bian Liu

doi:10.1371/journal.pone.0148444

Wendan Tao, Junfeng Liu + Show 6 more

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https://doi.org/10.1371/journal.pone.0148444

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Abstract

Background and ObjectiveElevated levels of high sensitivity cardiac troponin T (hs-cTnT) occur in a substantial proportion of patients with acute ischemic stroke (AIS) and can predict poor outcome and mortality after stroke. Whether elevated hs-cTnT levels can also predict hemorrhagic transformation (HT) or prognosis in AIS patients with rheumatic heart disease (RHD) remains unclear.MethodsData from the Chengdu Stroke Registry on consecutive AIS patients with RHD admitted to West China Hospital within1 month of stroke onset from October 2011 to February 2014 were examined. Clinico-demographic characteristics, HT, functional outcomes and stroke recurrence were compared between patients with elevated hs-cTnT levels(≥14ng/L) and patients with normal hs-cTnT levels (<14ng/L).ResultsThe final analysis involved 84 patients (31 males; mean age, 61.6±12.2years), of whom serum hs-cTnT levels were elevated in 58.3%. Renal impairment was independently associated with elevated hs-cTnT levels (OR 4.184, 95%CI 1.17 to 15.01, P = 0.028), and patients with elevated hs-cTnT levels were at significantly higher risk of HT, 3-month mortality and 3-month disability/mortality (all P≤0.029). After controlling for age, sex, hypertension, renal impairment and National Institutes of Health Stroke Scale score on admission, the risk of HT and 3-month mortality was, respectively, 4.0- and 5.5-fold higher in patients with elevated hs-cTnT levels than in patients with normal hs-cTnT levels.ConclusionElevated hs-cTnT levels are independently associated with HT and 3-month mortality in AIS patients with RHD. These results with a small cohort should be verified and extended in large studies.

Highlights

Rheumatic heart disease (RHD) affects 1.86 per 1000 adults in China, a prevalence 10-fold higher than in the industrialized countries of Canada (0.22 per 1000) and Japan (0.14 per 1000) [1]
The final analysis involved 84 patients (31 males; mean age, 61.6±12.2years), of whom serum hs-cardiac troponin T (cTnT) levels were elevated in 58.3%
Renal impairment was independently associated with elevated high sensitivity cardiac troponin T (hs-cTnT) levels, and patients with elevated hs-cTnT levels were at significantly higher risk of hemorrhagic transformation (HT), 3-month mortality and 3-month disability/mortality

Summary

Introduction

Rheumatic heart disease (RHD) affects 1.86 per 1000 adults in China, a prevalence 10-fold higher than in the industrialized countries of Canada (0.22 per 1000) and Japan (0.14 per 1000) [1]. We have previously shown that RHD-associated stroke is common in China, and that it occurs in younger people and causes more severe symptoms at hospital admission than other types of stroke[2].That study showed RHD to be associated with greater risk of death and stroke recurrence[2] These results establish the importance of RHD as a cause of stroke, in China, and highlight the need to identify independent predictors of prognosis in these patients at particular risk of poor outcome and complications after stroke, such as hemorrhagic transformation (HT). Whether elevated hs-cTnT levels can predict hemorrhagic transformation (HT) or prognosis in AIS patients with rheumatic heart disease (RHD) remains unclear

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Discussion

Conclusion