Troponin Levels in Patients in Acute Phase of Stroke
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Abstract
Background and Purpose: The purpose of this study was to assess the correlation of cTn levels in the acute phase of ischemic stroke with the extent of stroke, the degree of disability assessed on the modified Rankin Scale, and their prognostic significance.
Methods: Patients were divided into 3 groups: (A) ischemic strokes, (B) ischemic strokes followed by hemorrhagic transformation, and (C) hemorrhagic strokes, excluding patients with symptoms of acute coronary syndrome. Cardiac troponin levels (cTn) were determined by venipuncture using the Abbott ARCHITECT STAT hs Troponin-I assay.
Results: Seventy-four percent of the patients (128/173) were diagnosed with ischemic stroke, 14% (24/173) with ischemic stroke followed by hemorrhagic transformation, and 12% (21/173) with hemorrhagic stroke. The mean troponin level was 0.21 ± 1.15 ng/mL in the whole group (from 0 up to 12.4 ng/mL), while in the group with ischemic stroke the mean troponin level was 0.15 ± 076 ng/mL (from 0 up to 7.9 ng/mL). In 79/128 patients with ischemic stroke, troponin values were normal. Troponin levels were significantly correlated with the modified Rankin Scale on admission and on the day of discharge (p = 0.0001). Hyperlipidemia present in 104 patients had a statistically significant effect on statistically higher troponin levels (0.15 ± 0.80 ng/mL). In 48% of the cases, vascular lesions involved the vascular area of the middle cerebral artery (83 patients), while the rarest ones were in the basal ganglia area (4 patients). In the case of cerebellum changes, statistically significantly lower troponin levels were found than in the other groups (p = 0.050).
Conclusions: A moderate increase in troponin was observed in patients with cerebral stroke. Elevated troponin levels indicated the lesion size and correlated with the degree of disability. High troponin levels can be a prognostic factor in the course of stroke.
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Tesson A, Abdo R, Kamath A, Sutter J, Cline R, et al. (2018) HEART failure? Episodes of missed major cardiac events when applying the HEART pathway to an observation unit population. Crit Pathw Cardiol 17: 88-94. Link: https://goo.gl/TVcn7Y
Noorvash D, Ramos R, Hatch L, Muck A, Olson AS (2018) Assessment of the utility of ordering a troponin in low- and intermediate-risk patients presenting to the Emergency Department with supraventricular tachycardia: A retrospective chart review. J Emerg Med 55: 1-6. Link: https://goo.gl/v9mAjL
Hedberg P, Valkama J, Suvanto E, Pikkujämsä S, Ylitalo K (2006) Evaluation of innotrac aio! Second-generation cardiac troponin I assay: the main characteristics for routine clinical use. J Autom Methods Manag Chem 2006: 39325. Link: https://goo.gl/rqTxC6
Bellan M, Pirisi M, Bellomo G, Sainaghi PP (2017) A case of false positive Troponin I in a patient affected by cryoglobulinemic vasculitis. Reumatismo 69: 40-42. Link: https://goo.gl/MN75mi
Batal O, Jentzer J, Balaney B, Kolia N, Hickey G, et al. (2016) The prognostic significance of troponin I elevation in acute ischemic stroke. Journal of Critical Care 31: 41-47. Link: https://goo.gl/CLGVT2
Abdi S, Oveis-Gharan S, Sinaei F, Ghorbani A (2015) Elevated troponin T after acute ischemic stroke: Association with severity and location of infarction. Iran J Neurol 14: 35-40. Link: https://goo.gl/i6R1HU
Mochmann HC, Scheitz JF, Petzold GC, Haeusler KG, Audebert HJ, et al. (2016) Coronary angiographic findings in acute ischemic stroke patients with elevated cardiac troponin: The troponin elevation in acute ischemic stroke (TRELAS) study. Circulation 133: 1264-1271. Link: https://goo.gl/TFBty7
VanHouten J, Fricker G, Collins B, Bhatia R, Ellis C, et al. (2018) Circulating troponin I level in patients with acute ischemic stroke. Curr Neurol Neurosci Rep 18: 32. Link: https://goo.gl/21CLNL
Willeit P, Welsh P, Evans JDW, Tschiderer L, Boachie C, et al. (2017) High-sensitivity cardiac troponin concentration and risk of first-ever cardiovascular outcomes in 154,052 participants. J Am Coll Cardiol 70: 558-568. Link: https://goo.gl/N8N35Y
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, et al. (2013) An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44: 2064-2089. Link: https://goo.gl/tSr3vL
Dijkland SA, Voormolen DC, Venema E, Roozenbeek B, Polinder S, et al. (2018) Utility-weighted modified Rankin Scale as primary outcome in stroke trials: A simulation study. Stroke 49: 965–971. Link: https://goo.gl/CTaQYU
Chaisinanunkul N, Adeoye O, Lewis RJ, Grotta JC, Broderick J, et al. (2015) Adopting a patient-centered approach to primary outcome analysis of acute stroke trials using a utility-weighted modified Rankin Scale. Stroke 46: 2238-2243. Link: https://goo.gl/ZYJVWW
Lasek-Bal A, Kowalewska-Twardela T, Gąsior Z, Warsz-Wianecka A, Haberka M, et al. (2014) The significance of troponin elevation for the clinical course and outcome of first-ever ischaemic stroke. Cerebrovasc Dis 38: 212-218. Link: https://goo.gl/wYsZfd
Scheitz J, Mochmann HC, Erdur H, Tütüncü S, Haeusler KG, et al. (2014) Prognostic relevance of cardiac troponin T levels and their dynamic changes measured with a high-sensitivity assay in acute ischaemic stroke: Analyses from the TRELAS cohort. Int J Cardiol 177: 886-893. Link: https://goo.gl/q3p6Zf
Budincevic H, Sremec J, Crnac P, Ostojic V, Galic E, et al. (2017) Impact of troponin I on outcome of ischemic stroke patients. Rom J Intern Med 55: 19-22. Link: https://goo.gl/XzHehs
Thalin C, Rudberg AS, Johansson F, Jonsson F, Laska AC, et al. (2015) Elevated troponin levels in acute stroke patients predict long-term mortality. J Stroke Cerebrovasc Dis 24: 2390-2396. Link: https://goo.gl/ugYBts
Song HS (2008) Cardiac troponin T elevation after stroke: relationships between elevated serum troponin T, stroke location, and prognosis. J Clin Neurol 4: 75-83. Link: https://goo.gl/mgAqjw
Hasirci B, Okay M, Agircan D, Kocer A (2013) Elevated troponin level with negative outcome was found in ischemic stroke. Cardiovasc Psychiatry Neurol 2013: 953672. Link: https://goo.gl/3a4HtJ
Rincon F, Dhamoon M, Moon Y, Paik MC, Boden-Albala B, et al. (2008) Stroke location and association with fatal cardiac outcomes: Northern Manhattan Study (NOMAS). Stroke 39: 2425–2431. Link: https://goo.gl/fTyHJv
Oppenheimer SM, Kedem G, Martin WM (1996) Left-insular cortex lesions perturb cardiac autonomic tone in humans. Clin Auton Res 6: 131–140. Link: https://goo.gl/cvMZSf
Laowattana S, Zeger SL, Lima JA, Goodman SN, Wittstein IS, et al. (2006) Left insular stroke is associated with adverse cardiac outcome. Neurology 66: 477–483. Link: https://goo.gl/gKfrhS
Oppenheimer S, Hachinski V (1992) Complications of acute stroke. Lancet 339: 721–724. Link: https://goo.gl/zRQKmW
Scheitz JF, Mochmann HC, Nolte CH, Haeusler KG, Audebert HJ, et al. (2011) Troponin elevation in acute ischemic stroke (TRELAS)—protocol of a prospective observational trial. BMC Neurol 11: 98. Link: https://goo.gl/PthSBW
Su YC, Huang KF, Yang FY, Lin SK (2016) Elevation of troponin I in acute ischemic stroke. Peer J 4: e1866. Link: https://goo.gl/MTLY5y
Dous G, Grigos A, Grodman R (2017) Elevated troponin in patients with acute stroke—is it a true heart attack? Egypt Heart J 69: 165-170. Link: https://goo.gl/GzBiFT
Yoon M, Yang PS, Jang E, Yu HT, Kim TH, et al. (2018) Dynamic changes of cha2ds2-vasc score and the risk of ischaemic stroke in Asian patients with atrial fibrillation: A nationwide cohort study. Thromb Haemost 18: 1296-1304. Link: https://goo.gl/1A8p4s
Johnston KC, Li JY, Lyden PD, Hanson SK, Feasby TE, et al. (1998) Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. Stroke 29: 447-453. Link: https://goo.gl/UUdCYa
Christensen H, Boysen G, Christensen AF, Johannesen HH (2005) Insular lesions, ECG abnormalities, and outcome in acute stroke. J Neurol Neurosurg Psychiatry 76: 269–271. Link: https://goo.gl/qRc8Hq
Ripoll JG, Blackshear JL, Díaz-Gómez JL (2018) Acute Cardiac Complications in Critical Brain Disease. Neurosurg Clin N Am 29: 281-297. Link: https://goo.gl/P7jGwq
Biso S, Wongrakpanich S, Agrawal A, Yadlapati S, Kishlyansky M, et al. (2017) A review of neurogenic stunned myocardium. Cardiovasc Psychiatry Neurol 2017: 5842182. Link: https://goo.gl/gVUVog
Mierzewska-Schmidt M, Gawecka A (2015) Neurogenic stunned myocardium—do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure? Anaesthesiol Intensive Ther 47: 175-180. Link: https://goo.gl/SqdTX7
Murthy SB, Shah S, Venkatasubba Rao CP, Suarez JI, Bershad EM (2014) Clinical characteristics of myocardial stunning in acute stroke. J Clin Neurosci 21: 1279-1282. Link: https://goo.gl/ULKCKR