Elevation of cardiac biomarkers in stroke is associated with pathological findings on cardiac MRI—results of the HEart and BRain interfaces in Acute Stroke study

Abstract

Introduction Cardiac biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT), are frequently elevated in ischemic stroke patients but the mechanisms underlying this elevation are insufficiently understood. We determined the presence of cardiac damage, assessed using cardiac MRI (CMR), in stroke patients with elevated hs-cTnT and brain natriuretic peptide (BNP). Methods This is a post-hoc analysis of the prospective, investigator-initiated, cross-sectional HEBRAS (HEart and BRain interfaces in Acute Stroke) study. All patients underwent measurement of hs-cTnT and BNP as well as gadolinium-enhanced CMR in the acute phase of ischemic stroke. We performed unadjusted and adjusted logistic regression models to assess the association between hs-cTnT and BNP elevation and the presence of pathological CMR findings. Results Two hundred and thirty three stroke patients (median age 67 years, 33% female) were included, of whom 43 (21%) had elevated hs-cTnT and 109 (47%) had elevated BNP. 100 of the 233 (43%) patients had pathological findings on CMR had focal fibrosis as detected by late-gadolinium enhancement (LGE) in 51 (23%), left-ventricular hypertrophy (LVH) in 38 (16%), reduced LVEF in 32 (14%) and left atrial dilatation in 34 (15%). After adjustment for potential confounders, both hs-cTnT (adjOR 5.0 (95%CI 2.1-11.7), p<0.001) and BNP (adjOR 4.1 (95%CI 2.3-7.3), p<0.001) were significantly associated with pathological findings on CMR. Hs-cTnT was associated with LGE, LVEF and LVH, whereas BNP was associated with left atrial dilatation and LVEF, LVH. Conclusion Elevated cardiac biomarkers in acute stroke including CMR are strongly associated with pathological findings on CMR. In acute stroke patients, elevation of cardiac biomarkers may identify patients who require a more thorough cardiology work-up.

Stroke–heart syndrome: current progress and future outlook

“…Brain natriuretic peptide (BNP) and N-terminal pro-Btype natriuretic peptide (NT-proBNP) serve as predictors of post-stroke cardiac dysfunction [77]. NT-proBNP levels significantly increased within 24 h of AIS onset, whereas BNP correlated with left ventricular hypertrophy, left atrial dilatation, and LVEF [78,79]. NT-proBNP levels are independently associated with all-cause mortality at 90 days [55].…”

The diversity of global stroke research in the IJS

“…An interesting paper in this issue from von Rennenberg and colleagues addresses their importance, by relating elevated troponin levels to the presence of cardiac damage assessed using cardiac magnetic resonance imaging (MRI). 24 From the cross-sectional HEart and BRain interfaces in Acute Stroke (HEBRAS) study, they identified 237 patients with ischemic stroke, 43 (21%) of whom had elevated troponin. After adjustment for potential confounders, troponin was associated with pathological findings on cardiac MRI (adjusted odds ratio (aOR) = 5.0 (95% CI, 2.1–11.7), p < 0.001), and specifically with late-gadolinium enhancement, left-ventricular hypertrophy and left-ventricular ejection fraction.…”