Cardiac Vulnerability to Cerebrogenic Stress as a Possible Cause of Troponin Elevation in Stroke

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Ji‐Sung Lee¹  Yeon‐Jung Kim²  Sun U. Kwon²  Bum‐Joon Kim²  Sung‐Ho Ahn²  Dong‐Wha Kang²  Jong S. Kim²  Hyun‐Goo Kang³  Sang‐Mi Noh⁴  Seung‐Min Kim⁵  Young‐Hak Kim⁶  Chol‐Ho Shin⁷ 

[1] Clinical Research Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea;Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea;Department of Neurology, Chosun University Hospital, Gwangju, South Korea;Department of Neurology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea;Department of Neurology, Veterans Health Service Medical Center, Seoul, South Korea;Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea;Medical School, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea;

关键词: cardiac disease;    electrocardiography;    infarction;    insular;    troponin;   

DOI  :  10.1161/JAHA.116.004135

来源: DOAJ

【 摘 要 】

BackgroundTroponin elevation with electrocardiography changes is not uncommon in patients with acute ischemic stroke; however, it is still unclear whether the mechanism of these changes is due to cardiac problems or neurally mediated myocytic damage. Thus, we investigated cardiac and neurological predictors of troponin elevation in those patients. Methods and ResultsWe retrospectively analyzed medical data of the prospectively registered ischemic stroke patients on stroke registry who were admitted and underwent a serum cardiac troponin I and 12‐lead electrocardiography within 24 hours of symptom onset. However, patients with well‐known troponin‐elevating comorbidities were excluded from the analysis. Among 1404 ischemic stroke patients, 121 (8.7%) had elevated troponin, which was defined as more than 0.04 mg/mL. Multivariable analysis identified electrocardiography abnormalities such as QTc‐prolongation (odds ratio [OR]: 1.52, 95% CI: 1.02–2.28), left ventricular hypertrophy (OR: 2.14, 95% CI 1.43–3.19), Q‐wave (OR: 2.53, 95% CI: 1.48–4.32), and ST elevation (OR: 2.74, 95% CI: 1.12–6.72) as cardiac variables associated with troponin elevation, and higher National Institutes of Health Stroke Scale score (OR: 1.04, 95% CI: 1.01–1.07) and insular cortical lesions (OR: 2.78, 95% CI: 1.85–4.19) as neurological variables associated with troponin elevation. Incidence of troponin elevation as well as QTc‐prolongation was increased further in combination with cardiac and neurological factors. ConclusionsCertain cardiac and neurological conditions in acute ischemic stroke may contribute to troponin elevation. The proposed concept of cardiac vulnerability to cerebrogenic stress can be a practical interpretation of troponin elevation and electrocardiography abnormalities in stroke patients.

【 授权许可】

Unknown