Cardiac dysfunction and high-sensitive C-reactive protein are associated with troponin T elevation in ischemic stroke: insights from the SICFAIL study

Abstract

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 m2 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.

Stroke Related Brain–Heart Crosstalk: Pathophysiology, Clinical Implications, and Underlying Mechanisms

“…[ 17 ] Following AIS, 23.6% develop AF, 10.4% develop systolic dysfunction, and 24.5% develop diastolic dysfunction. [ 18 ] The study from Adeoye et al. found that a third of 1020 adult patients with acute stroke had systolic dysfunction, highly associated with 1‐month mortality.…”

“…[17] Following AIS, 23.6% develop AF, 10.4% develop systolic dysfunction, and 24.5% develop diastolic dysfunction. [18] The study from Adeoye et al found that a third of 1020 adult patients with acute stroke had systolic dysfunction, highly associated with 1-month mortality. [19] Electrocardiogram (ECG) abnormalities within the initial 24 hours are frequently observed in 85% of acute stroke patients.…”

Cerebrocardial Continuum in Patients After a Stroke

“…Дослідження SICFAIL виявили, що у значної кількості хворих з ішемічним інсультом виявляють субклінічну та клінічну картину серцевої недостатності (Heuschmann et al, 2021). З іншого боку, 5-річна частота рецидивів інсульту у пацієнтів із серцевими ускладненнями після ішемічного інсульту перевищує 50% [37,38].…”