High-Sensitivity Cardiac Troponin T and Cognitive Function in Patients With Ischemic Stroke

Abstract

Background and Purpose— Our study aim was to assess whether high-sensitivity cardiac troponin T (hs-cTnT), a specific biomarker for myocardial injury, is associated with cognitive function in patients after mild-to-moderate first-ever ischemic stroke. Methods— We used data from PROSCIS-B (Prospective Cohort With Incident Stroke Berlin). Cognitive function was assessed by Mini-Mental-State-Examination at baseline, and Telephone Interview for Cognitive Status–modified after 1 to 3 years of follow-up. Patients were categorized according to hs-cTnT quartiles. We performed generalized linear regression to calculate risk ratios of cognitive impairment (Mini-Mental-State-Examination <27; Telephone Interview for Cognitive Status–modified <32). Association of hs-cTnT with cognitive function over time was estimated using a linear mixed model. Results— We included 555 patients (mean age, 67 years, 62% male, median National Institutes of Health Stroke Scale 2 [interquartile range, 1–5], hs-cTnT above upper reference limit 40%, baseline cognitive impairment 28%). Baseline Mini-Mental-State-Examination score and rate of cognitive impairment were lower in patients in the highest versus lowest hs-cTnT quartile (median Mini-Mental-State-Examination 27 versus 29, and 15.3% versus 43.0%, adjusted risk ratio, 1.76 [95% CI, 1.07–2.90], respectively). If anything, cognition seemed to improve in all groups, yet Telephone Interview for Cognitive Status–modified scores were consistently lower in patients within the highest versus lowest hs-cTnT quartile (adjusted β, −1.33 [95% CI, −2.65 to −0.02]), without difference in the rate of change over time. Conclusions— In patients with mild-to-moderate first-ever ischemic stroke without dementia, higher hs-cTnT was associated with higher prevalence of cognitive impairment at baseline and lower Telephone Interview for Cognitive Status–modified during 3-year follow-up. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01363856.

Comment on: “Experimental ischaemic stroke induces transient cardiac atrophy” by Veltkamp et al.

“…9 The current study provides important insides into the mechanisms of cardiac damage triggered by cerebral ischaemia and contributes to the understanding of the brain-heart syndrome. 10 In line with presented results, elevated high-sensitive cardiac troponin T levels have been frequently observed after stroke. 10,11 In the present study, the authors additionally investigated echocardiographic parameters, such as LVEF and fractional shortening.…”

“…10 In line with presented results, elevated high-sensitive cardiac troponin T levels have been frequently observed after stroke. 10,11 In the present study, the authors additionally investigated echocardiographic parameters, such as LVEF and fractional shortening. The changes of these parameters were observed only in mice with MCAO lasting not 30 min but 60 min.…”

Soluble ST2 and Risk of Cognitive Impairment after Acute Ischemic Stroke: A Prospective Observational Study

“…Interview for Cognitive Status-modi ed during 3-year follow-up in patients with mild-to-moderate ischemic stroke [20]. The present study, to our knowledge, was the rst longitudinal study to directly characterize the relationship of sST2 and PSCI, extending the connection of heart and brain to the patients with ischemic stroke.…”

“…Recently, the PROSCIS-B (Prospective Cohort With Incident Stroke Berlin) study reported that higher hs-cTnT was associated with higher prevalence of cognitive impairment at baseline and lower Telephone Interview for Cognitive Status-modi ed during 3-year follow-up in patients with mild-to-moderate ischemic stroke [20]. The present study, to our knowledge, was the rst longitudinal study to directly characterize the relationship of sST2 and PSCI, extending the connection of heart and brain to the patients with ischemic stroke.…”

“…BP measurements were performed by trained nurses according to a standard protocol adapted from procedures recommended by the American Heart Association. [18,19] or MMSE score of less than 27 [20].…”