Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Zhang, Limin; Wang, Zhilong; Qi, Shijie

doi:10.1016/j.jstrokecerebrovasdis.2015.06.030

Cited by 43 publications

(39 citation statements)

References 50 publications

(99 reference statements)

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“…In the setting of these syndromes, elevation of cardiac troponins also served as prognostic markers to predict adverse consequences of heart failure even in the absence of coronary artery stenosis . Moreover, cardiac troponin elevation has been reported in a number of nonmyocardial ischemic conditions including pulmonary embolism, sepsis syndrome, renal insufficiency and subarachnoid hemorrhage (SAH), and served as prognostic makers with different clinical implications . Particularly, elevated cardiac troponin is associated with an increasingly delayed cerebral ischemia, poor outcomes and death in SAH patients, playing an important role in predicting the prognostic value of the other type of hemorrhagic stroke.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of elevated cardiac troponin I in patients with intracerebral hemorrhage

Yang

Liu

Wang

et al. 2019

Clinical Cardiology

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Background Although cardiac troponin has been well established as diagnostic and prognostic makers for acute coronary heart disease, the prognostic value of elevated cardiac troponin in patients with intracerebral hemorrhage (ICH) was inconsistent and not systematically evaluated. Hypothesis We proposed the hypothesis that the practical utility of cardiac troponin levels for prediction of mortality and poor outcome in ICH patients. Methods A total of 1004 patients with ICH were retrospectively reviewed and qualified for further analysis from June 2012 to December 2015. The patients were divided into different groups based on measurements of cardiac troponin I (cTnI) at the time of admission and the following day. Multivariate Cox proportional hazards analysis were performed to determine the independent prognostic value of the cTnI for patients in‐hospital mortality and poor outcomes, the receiver operator characteristic (ROC) analysis was performed to assess the predictive value of cTnI, ICH score, and combination of them. Results Serum cTnI level was an independent predictor in‐hospital mortality (positive vs negative, HR (hazard ratios) = 3.44, 95% CI (confidence interval) 1.66‐7.13, P < .001) and poor outcomes in patients with ICH (positive vs negative, HR = 6.69, 95% CI 4.25‐10.52, P < .001). Addition of cTnI to ICH score significantly improved the prognostic discrimination for both in‐hospital mortality and poor outcomes. Conclusion Serum cTnI levels may be valuable as predictor for in hospital mortality and poor outcomes and may be useful in the risk stratification of ICH during hospitalization.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of elevated cardiac troponin I in patients with intracerebral hemorrhage

Yang

Liu

Wang

et al. 2019

Clinical Cardiology

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“…Thus, serum troponin levels might play a pivotal role in stroke patients and are associated with the severity of stroke. However, most of the studies on cardiac troponin and stroke were performed in patients with cerebral infarct or subarachnoid hemorrhage (SAH; Batal et al., ; Zhang, Wang, & Qi, ). Little is known about the effect of cardiac troponin in ICH patients, especially the relationship of elevated troponin and cerebral herniation, as well as the association between elevated troponin and hematoma volume.…”

Section: Introductionmentioning

confidence: 99%

Cardiac troponin and cerebral herniation in acute intracerebral hemorrhage

Lin

Wang

et al. 2017

Brain and Behavior

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ObjectivesTo explore the association, if any, between the relationship between cardiac troponin and cerebral herniation after intracerebral hemorrhage (ICH).MethodsSix hundred and eighty‐seven consecutive ICH patients admitted to West China Hospital from May 1, 2014 to September 1, 2015 were retrospectively reviewed. Data on demographics, etiology, laboratory examinations at admission including serum cardiac troponin, computed tomography (CT) scans at admission and follow‐up, and clinical outcomes were obtained. Using multiple logistic regression to identify the relationship of troponin and herniation. The association between troponin and hematoma volume was assessed using bivariate correlation and linear regression.ResultsAmong 188 (27.4%) patients who underwent the test of serum cardiac troponin at admission, 16 (8.5%) demonstrated cerebral herniation. The median time from symptom onset to CT at admission and follow‐up was 4 and 30.25 hr, respectively. In multivariate analysis, elevated troponin was independently associated with cerebral herniation (adjusted odds ratio [OR] 5.19; 95% confidence interval [CI], 1.08–24.93). And those with elevated troponin had larger hematoma volume at follow‐up in bivariate correlation (correlation coefficient, .375, p = .003) and linear regression (β, .370, 95% CI, 0.062–0.320, p = .005), higher National Institutes of Health Stroke Scale score (adjusted OR 2.06; 95% CI, 1.06–4.01, p = .033) and lower Glasgow Coma Scale score (adjusted OR 2.34; 95% CI, 1.17–4.68, p = .016) than those without.ConclusionsElevated cardiac troponin was associated with an almost five‐fold increased risk of cerebral herniation, but not in‐hospital mortality. The possibility of cerebral herniation should be considered when ICH patients with large hematoma volume and elevated troponin.

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“…In another meta-analysis, cardiac troponin elevation was also reported to be associated with increased risk of late cerebral ischemia and death in patients with spontaneous subarachnoid hemorrhage (13). In a study conducted by Xu et al, troponin elevations were found to be associated with intracranial herniation in patients followed up with intracerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 93%

Comparison of troponin levels in isolated middle cerebral artery and anterior system tandem occlusion treated with mechanical thrombectomy

Şengeze¹,

Gıray²,

İnanç³

et al. 2019

TÃ¼rk Beyin Damar Hast Derg

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INTRODUCTION: Ischemic stroke is the most common disability worldwide and the second most common cause of mortality. One of the major causes of mortality in patients with ischemic stroke is cardiac complications. However, high levels of troponin may be caused in patients with ischemic stroke and many of the systemic diseases that has a risk for the stroke. In this study, we aimed to investigate troponin levels of stroke patients who were treated with mechanical thrombectomy and the resulting risk factors for stroke, mortality and physical dependence at the end of the third month in tandem and M1 occlusions. METHODS: In this study, troponin values are examined retrospectively in stroke patients with tandem occlusion of the anterior circulation and middle cerebral artery M1 occlusions, who were treated between January 2015 and February 2019. SPSS Windows 23 package program was used in the statistical analysis of the data obtained from the study. Troponin values in tandem and middle cerebral artery occlusion were compared with chi-square method. Results were evaluated at 95% confidence interval and p<0.05 level of significance. RESULTS: When the mortality rates between tandem and MCA occlusions were examined at the end of the third month, mortality rates were higher in tandem occlusions and there was a statistically significant difference between the two groups (p: 0.027). There was no significant difference between tandem and MCA occlusions in terms of troponin values (p: 0.63). Patients with troponin values above 0.028 ng / mL had significantly higher mortality at 3 months. DISCUSSION and CONCLUSION: There is a relationship between mortality and elevation of troponin levels in patients who had tandem and MCA occlusions. However, there was no difference between tandem and MCA occlusions in terms of troponin values significantly. There is a need to further study the impact of ischemic stroke on troponin levels with randomized, controlled studies. MEKANİK TROMBEKTOMİ İLE TEDAVİ EDİLEN İZOLE ORTA SEREBRAL ARTER VE ÖN SİSTEM TANDEM OKLÜZYONU OLGULARINDAKİ TROPONİN DÜZEYLERİNİN KARŞILAŞTIRILMASIÖZET GİRİŞ ve AMAÇ: İskemik inme tüm dünyada en sık sakatlık bırakan ve ikinci sıklıkta mortaliteye neden olan hastalıktır. İskemik inme geçiren hastalarda mortalitenin önemli nedenlerinden biri de kardiyak komplikasyonlardır. Troponin, akut miyokard infarktüsünün tanısında ve akut koroner semptomları olan hastaların risk sıralamasında kullanılan yüksek duyarlılığı ve özgünlüğü olan bir belirteçtir. Bununla birlikte, iskemik inmeli hastalarda troponin yüksekliğine inme için ri sk oluşturan sistemik hastalıkların birçoğu neden olabilmektedir. Biz çalışmamızda mekanik trombektomi ile tedavi ettiğimiz tandem oklüzyonlar ve orta serebral arter M1 oklüzyonlarındaki troponin seviyelerini, inme risk faktörlerini, üçüncü ay sonundaki mortalite ve fiziksel bağımlılığı incelemeyi amaçladık. YÖNTEM ve GEREÇLER: Çalışmada Ocak 2015-Şubat 2019 yılları arasından hastanemize başvuran ve mekanik trombektomi ile tedavi edilen ön sistem tandem okl...

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Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Cited by 43 publications

References 50 publications

Prognostic value of elevated cardiac troponin I in patients with intracerebral hemorrhage

Prognostic value of elevated cardiac troponin I in patients with intracerebral hemorrhage

Cardiac troponin and cerebral herniation in acute intracerebral hemorrhage

Comparison of troponin levels in isolated middle cerebral artery and anterior system tandem occlusion treated with mechanical thrombectomy

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