Key result
Systolic dysfunction linked to ~179% higher odds of elevated hs-TnT in ischemic stroke patients.
Why the study?
Troponin elevation is common in ischemic stroke, but the underlying coronary and non-coronary pathomechanisms such as autonomic dysfunction remain incompletely understood.
Cohort (n=543)
No
In patients with acute ischemic stroke, elevated high-sensitive troponin T is independently associated with underlying cardiac dysfunction and inflammation, but not with autonomic dysfunction as measured by heart rate variability.
Elevated hs-TnT in acute ischemic stroke links to systolic dysfunction and inflammation; hypothesis-generating for mechanisms and management.
Background Troponin elevation is common in ischemic stroke (IS) patients. The pathomechanisms involved are incompletely understood and comprise coronary and non-coronary causes, e.g. autonomic dysfunction. We investigated determinants of troponin elevation in acute IS patients including markers of autonomic dysfunction, assessed by heart rate variability (HRV) time domain variables. Methods Data were collected within the Stroke Induced Cardiac FAILure (SICFAIL) cohort study. IS patients admitted to the Department of Neurology, Würzburg University Hospital, underwent baseline investigation including cardiac history, physical examination, echocardiography, and blood sampling. Four HRV time domain variables were calculated in patients undergoing electrocardiographic Holter monitoring. Multivariable logistic regression with corresponding odds ratios (OR) and 95% confidence intervals (CI) was used to investigate the determinants of high-sensitive troponin T (hs-TnT) levels ≥14 ng/L. Results We report results from 543 IS patients recruited between 01/2014–02/2017. Of those, 203 (37%) had hs-TnT ≥14 ng/L, which was independently associated with older age (OR per year 1.05; 95% CI 1.02–1.08), male sex (OR 2.65; 95% CI 1.54–4.58), decreasing estimated glomerular filtration rate (OR per 10 mL/min/1.73 m 2 0.71; 95% CI 0.61–0.84), systolic dysfunction (OR 2.79; 95% CI 1.22–6.37), diastolic dysfunction (OR 2.29; 95% CI 1.29–4.02), atrial fibrillation (OR 2.30; 95% CI 1.25–4.23), and increasing levels of C-reactive protein (OR 1.48 per log unit; 95% CI 1.22–1.79). We did not identify an independent association of troponin elevation with the investigated HRV variables. Conclusion Cardiac dysfunction and elevated C-reactive protein, but not a reduced HRV as surrogate of autonomic dysfunction, were associated with increased hs-TnT levels in IS patients independent of established cardiovascular risk factors. Registration-URL: https://www.drks.de/drks_web/; Unique identifier: DRKS00011615.
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Montellano et al. (2022) conducted a cohort in Ischemic stroke (n=543). Systolic dysfunction vs. No systolic dysfunction was evaluated on High-sensitive troponin T (hs-TnT) ≥14 ng/L (OR 2.79, 95% CI 1.22-6.37). Systolic dysfunction (OR 2.79) and elevated C-reactive protein (OR 1.48 per log unit) were independently associated with increased high-sensitive troponin T levels in ischemic stroke patients.
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