Abstract
BackgroundA proportion of patients with acute ischemic stroke have elevated cardiac troponin levels and ECG changes suggestive of cardiac injury, but the etiology is unclear. The aims of this study were to assess the frequency of high sensitivity cardiac troponin T (hs-cTnT) elevation, to identify determinants and ECG changes associated with hs-cTnT elevation, to identify patients with myocardial ischemia and to assess the impact of hs-cTnT elevation on in-hospital mortality.MethodsPatients discharged with a diagnosis of acute ischemic stroke during a 1-year period, were included. Patients diagnosed with acute myocardial infarction (MI) within the last 7 days before admission or during hospitalization were excluded.ResultsIn all, 156 (54.4%) of 287 patients had elevated hs-cTnT. The factors independently associated with hs-cTnT elevation were age ≥ 76 years (OR 3.71 [95% CI 2.04-6.75]), previous coronary heart disease (CHD) (OR 2.61 [1.23-5.53]), congestive heart failure (OR 4.26 [1.15-15.82]), diabetes mellitus (OR 4.02 [1.50-10.76]) and lower eGFR (OR 0.97 [0.95-0.98]). Of the 182 patients who had two hs-cTnT measurements, 12 (6.6%) had both a rise or fall of hs-cTnT with at least one elevated value, and ECG manifestations of myocardial ischemia, e.g. meeting the criteria of acute MI. Both dynamic relative change (p = 0.026) and absolute change (p = 0.032) in hs-cTnT were significantly associated with higher in-hospital mortality.ConclusionsEstablished CHD and cardiovascular risk factors are associated with hs-cTnT elevation. Acute MI is likely underdiagnosed in acute ischemic stroke patients. Dynamic changes in troponin levels seem to be related to poor short-term prognosis.
Highlights
A proportion of patients with acute ischemic stroke have elevated cardiac troponin levels and ECG changes suggestive of cardiac injury, but the etiology is unclear
More widespread use of the highly sensitive assays have led to substantial increase in the detection of elevated levels of cardiac troponin, even among patients admitted for other conditions [6], such as end-stage renal disease (ESRD) [3,7], pulmonary embolism (PE) [8] and epileptic seizures [9]
The principal findings in this study among patients admitted with acute ischemic stroke are: i) high sensitivity cardiac troponin T (hs-cTnT) was higher than the upper reference limit (URL) in 53.4% of the patients; ii) 6.6% of the patients met the criteria of acute myocardial infarction (MI); iii) patients with elevated hs-cTnT more frequently had ST segment depression and T-wave inversion on ECG, and iv) higher age, history of coronary heart disease (CHD) and congestive heart failure, presence of diabetes mellitus and renal dysfunction were variables significantly associated with hs-cTnT elevation
Summary
A proportion of patients with acute ischemic stroke have elevated cardiac troponin levels and ECG changes suggestive of cardiac injury, but the etiology is unclear. In a systematic review [15], the prevalence of cardiac troponin elevation in stroke patients was reported to vary from 0 to 34%, but the studies reviewed were heterogeneous and difficult to compare due to different troponin assays and cut-offs. It is uncertain whether this elevation is transient or chronic and whether the etiology is acute myocardial ischemia or comorbidities. Stroke patients often manifest electrocardiography (ECG) changes suggestive of cardiac injury [16,17], but the etiology is unclear
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