Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study

Abstract

Objective To assess whether a raised serum troponin T concentration would be an independent predictor of death in patients with an acute ischaemic stroke. Design Observational study. Setting Auckland Hospital, Auckland, New Zealand. Subjects All 181 patients with an acute ischaemic stroke admitted over nine months in 1997-8, from a total of 8057 patients admitted to the acute medical service. Main outcome measures Blood samples for measuring troponin T concentration were collected 12-72 hours after admission; other variables previously associated with severity of stroke were also recorded and assessed as independent predictors of inpatient mortality. Results Troponin T concentration was raised ( > 0.1 g/l) in 17% (30) of patients admitted with an acute ischaemic stroke. Thirty one patients died in hospital (12/30 (40%) patients with a raised troponin T concentration v 19/151 (13%) patients with a normal concentration (relative risk 3.2 (95% confidence 1.7 to 5.8; P = 0.0025)). Of 17 possible predictors of death, assessed in a multivariate stepwise model, only a raised troponin T concentration (P = 0.0002), age (P = 0.0008), and an altered level of consciousness at presentation (P = 0.0074) independently predicted an adverse outcome. Conclusions Serum troponin T concentration at hospital admission is a powerful predictor of mortality in patients admitted with an acute ischaemic stroke.

Serum Cardiac Troponin T Levels as an Indicator of Myocardial Injury in Ischemic and Hemorrhagic Stroke Patients

“…Cardiac abnormalities, as judged by release of cardiac enzymes, changes in electrocardiography (ECG), or clinical or echocardiographic evidence of left ventricular dysfunction usually develop just after intracerebral disorders (i.e., stroke, subarachnoid hemorrhage) (Bhagat et al 1997;James et al 2000). The exact underlying pathophysiological mechanism of this myocardial dysfunction could not be determined in many cases.…”

“…However the studies searching for cTnT which is more sensitive and specific to myocardium after stroke, is relatively scarce (James et al 2000;Parekh et al 2000). Moreover, to our knowledge, its associations with stroke volume and type of stroke have not been investigated thoroughly.…”

“…Other noncoronary related disorders resulting in elevation of cTnT are myocarditis, acute pulmonary edema, septic shock, cardiotoxic medication, cardioversion, ablation, percutaneous transcoronary angiography (PTCA) and renal insufficiency. Stroke, which also results in myocardial injury, causes elevation in cTnT levels (Mair 1997;James et al In addition to general systematic clinical assessment and physical examination of patients, detailed cardiac and neurological evaluation have been conducted by specialists for all cases. All patients underwent twelve-lead ECG, echocardiography and brain CT scan.…”

Elevated Cardiac Troponin T Predicts Adverse Outcomes in Hypertensive Patients

“…Several studies have shown that the amount of cTnT elevation is associated with a poor prognosis among patients with cerebrovascular disease. 13,14) However, the present study excluded patients with prior cerebrovascular disease. Reports indicate that DM and LV hypertrophy, which might be associated with ongoing myocardial damage according to the present study, are risk factors for cerebrovascular disease.…”

“…13,14) The present study evaluated the relationship between elevated cTnT and the development of cardiovascular and cerebrovascular diseases in hypertensive patients without left ventricular (LV) systolic dysfunction.…”