Prevalence of Positive Troponin and Echocardiogram Findings and Association With Mortality in Acute Ischemic Stroke

Abstract

Background and Purpose Acute ischemic stroke (AIS) patients may have raised serum troponin (cTn) levels on admission, although it is unclear what prognostic implications this has, and whether elevated levels are associated with cardiac causes of stroke or structural cardiac disease as seen on echocardiogram. We investigated the positivity of cTn and echocardiogram testing within a large biracial AIS population, and any association with post stroke mortality. Methods Within a catchment area of 1.3 million we screened ED admissions from 2010 using ICD-9 discharge codes 430–436 and ascertained all physician-confirmed AIS cases by retrospective chart review. Hypertroponinemia was defined as elevation in cTn above the standard 99th percentile. Multiple logistic regression was performed, controlling for stroke severity, history of cardiac disease and all other stroke risk factors. Results Of 1999 AIS cases, 1706 (85.3%) had a cTn drawn and 1590 (79.5%) had echocardiograms. Hypertroponinemia occurred in 353/1706 (20.7%). 160/1590 (10.1%) had echocardiogram findings of interest. Among 1377 who had both tests performed, hypertroponinemia was independently associated with echocardiogram findings (OR 2.9 95% CI 2–4.2). When concurrent myocardial infarctions (MI, 3.5%) were excluded, hypertroponinemia was also associated with increased mortality at 1 year (35%, OR 3.45 95% CI 2.1–5.6) and 3 years (60%, OR 2.91 95% CI 2.06–4.11). Conclusions Hypertroponinemia in the context of AIS without concurrent MI was associated with structural cardiac disease and long-term mortality. Prospective studies are needed to determine if further cardiac evaluation might improve the long-term mortality rates seen in this group.

Elevation of high‐sensitivity cardiac troponin T at admission is associated with increased 3‐month mortality in acute ischemic stroke patients treated with thrombolysis

“…Dynamic changes of hs‐cTn levels in AIS patients are associated with unfavorable outcomes, including death . In line with previous studies of circulating cTnT, assessed with conventional or high‐sensitivity assay, we confirmed the elevation of serum hs‐cTnT is predictive of mortality in AIS patients. Unfortunately, patient information regarding the serial measurement of hs‐cTnT in this study was incomplete for statistical analysis.…”

“…Moreover, clear evidence indicates that cardiac lesions can be observed following nervous system insults . Increased levels of cardiac troponin (cTn), as a strong indicator of cardiac injury, have been repeatedly reported to be associated with adverse outcomes in AIS patients . Cardiac troponins exist as structural proteins in a small free pool in cardiomyocytes, and will be released in a complex form of subunits after disease conditions .…”

Diagnostic Yield and Accuracy of Bedside Echocardiography in the Emergency Department in Hemodynamically Stable Patients

“…The diagnostic yield of FOCUS in the ED in our study was similar to that of several previous studies of TTE in other populations. In a recent study of more than 1000 patients with acute ischemic stroke, Wrigley et al found the prevalence of positive findings on echocardiography that “could possibly impact future management decisions,” including an EF of 35% or lower and an intracardiac thrombus, among others, was 10.7%. The yield of routine screening for first‐degree family members of patients with bicuspid aortic valves was 10.1% .…”

Hypertroponinemia, Structural Cardiac Disease, and Stroke Mortality

“…When the concomitant myocardial infarction (3,5%) was excluded from hypertroponinemia was also associated with increased mortality at 1 (35%) and 3 years (60%). 6 The results from this elegant and sophisticated statistical model evidence that the increase of cTn in patients with structural heart disease and who suffered a stroke has the highest risk of mortality. However, the results cannot be interpreted as if they reflected the real picture throughout the world.…”

“…To this regard, Wrigley et al 6 analyzed data of biracial population of 1.3 million is largely representative of the United States in terms of median age, proportion of black subjects, and economic status. The analysis was done in adult patients (aged 20 years and older) with AIS who presented to an emergency department.…”