Key result
Midline shift independently predicted the development of acute myocardial injury in patients with intracerebral hemorrhage (OR 3.29).
Why the study?
While myocardial injury is a known stroke complication mainly studied in ischemic stroke, little is known about its occurrence, predictors, and implications in intracerebral hemorrhage.
Cohort (n=322)
No
In patients with intracerebral hemorrhage, acute myocardial injury is frequent, independently predicted by midline shift, and associated with a higher rate of adverse cardiac events and poorer in-hospital outcomes.
Answers are grounded in this paper and cite their sources.
Myocardial injury may warrant troponin monitoring in ICH; leaves open whether it is a modifiable target for outcomes.
PURPOSE: Myocardial injury, indicated by an elevation of high-sensitive cardiac Troponin (hs-cTnT), is a frequent stroke-related complication. Most studies investigated patients with ischemic stroke, but only little is known about its occurrence in patients with intracerebral hemorrhage (ICH). This study aimed to assess the frequency, predictors, and implications of myocardial injury in ICH patients. METHODS: Our retrospective analysis included 322 ICH patients. We defined myocardial injury as an elevation of hs-cTnT above the 99th percentile (i.e. 14 ng/L). Acute myocardial injury was defined as either a changing pattern of > 50% within 24 h or an excessive elevation of initial hs-cTnT (> 52 ng/L). 3D brain scans were assessed for ICH visually and quantitatively by a deep learning algorithm. Multiple regression models and Voxel-based Lesion-Symptom Mapping (VLSM) were applied. RESULTS: 63.0% (203/322) of patients presented with myocardial injury, which was associated with more severe strokes and worse outcomes during the in-hospital phase (P < 0.01). Acute myocardial injury occurred in 24.5% (79/322) of patients. The only imaging finding associated with acute myocardial injury was midline shift (69.8% vs. 44.6% for normal or stable hs-cTnT, P < 0.01), which also independently predicted it (odds ratio 3.29, confidence interval 1.38-7.87, P < 0.01). In contrast, VLSM did not identify any specific brain region significantly associated with acute myocardial injury. Acute myocardial injury did not correlate with preexisting cardiac diseases; however, the frequency of adverse cardiac events was higher in the acute myocardial injury group (11.4% vs. 4.1% in patients with normal and/or stable patterns of hs-cTnT, P < 0.05). CONCLUSION: Myocardial injury occurs frequently in ICH and is linked to poor outcomes. Acute myocardial injury primarily correlates to space-occupying effects of ICH but is less dependent on premorbid cardiac status. Nonetheless, it is associated with a higher rate of adverse cardiac events.
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Hess et al. (2025) conducted a cohort in Intracerebral hemorrhage (n=322). Midline shift vs. No midline shift was evaluated on Acute myocardial injury (OR 3.29, 95% CI 1.38-7.87, p=<0.01). Midline shift independently predicted the development of acute myocardial injury in patients with intracerebral hemorrhage (OR 3.29).
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