Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke

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.

Increased High-Sensitivity Troponin-T Levels Are Associated with Mortality After Ischemic Stroke

“…A model based on stroke severity and presence of increased troponin at presentation had high specificity but low sensitivity for prediction of poor outcome or mortality at discharge. In agreement with previous data, the current study also demonstrated associations between troponin and other important risk factors for stroke and mortality, such as older age, coronary artery disease, congestive heart failure, renal failure, and diabetes (Faiz et al 2014a). However, the association between troponin and worse outcomes remained significant following a multivariate regression analysis that controlled for other risk factors.…”

“…Current assays can detect very small quantities of troponin and are therefore referred to as high-sensitivity troponin-T (hs-Tnt) and high-sensitivity troponin-I (hs-TnI). Previous studies that explored the significance of elevated troponin levels among stroke patients were inconsistent in their inclusion criteria, outcome definitions, percentage of patients with elevated troponins included, and the type of troponin isoenzyme measured (Faiz et al 2014a, b;Kerr et al 2009;Song et al 2008). Furthermore, most of these studies did not focus on the neurological disability but rather studied mortality ratios.…”

Troponins and other biomarkers in the early diagnosis of acute myocardial infarction

“…However, the type of troponin assay and cut-off levels used varied between studies, making them difficult to compare 68. In another study, 53.4% of patients with acute stroke had troponin levels above the upper reference level 69. In this study, patients with elevated hs-troponin values were significantly more likely to have ischaemic ECG changes, suggesting AMI may be underdiagnosed in patients with acute ischemic stroke 69…”

Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

“…In a study with serially measured cardiac troponin, the majority (60%) of the patients with increases in cardiac troponin showed a stable pattern and the remainder showed a rise and/or fall of Ͼ20% (41 ). Hence, "cardiac troponin positivity" in stroke does not necessarily indicate acute ongoing myocardial injury but may in some cases rather be explained by old age and comorbidities (e.g., HF, chronic coronary artery disease and renal failure, entities that are frequent among stroke patients) (42 ).…”