Highly Sensitive Troponin T in Patients with Acute Ischemic Stroke

Jensen, Jesper K.; Ueland, Thor; Aukrust, Pål; Antonsen, Lisbeth; Kristensen, Søren Risom; Januzzi, James L.; Ravkilde, Jan

doi:10.1159/000341340

Cited by 35 publications

(29 citation statements)

References 62 publications

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“…Recently higher Troponin T levels were found in older patients with a more severe ischemic stroke and with comorbidities such as heart failure and/or renal insufficiency [39]. Another study showed that elevated levels of high sensitive Troponin T are frequently present in patients with acute ischemic stroke but, in accordance to our results, did not provide additional prognostic information in these subjects [40]. Interestingly s-cTnI did also not provide additional information for the identification of cardioembolic aetiology in our study.…”

Section: Discussionsupporting

confidence: 79%

BNP but Not s-cTnln Is Associated with Cardioembolic Aetiology and Predicts Short and Long Term Prognosis after Cerebrovascular Events

et al. 2014

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BackgroundWe analyzed the prognostic value of b-type natriuretic peptide (BNP) and sensitive cardiac Troponin (s-cTnI) in patients with ischemic stroke or transient ischemic attack (TIA) and their significance in predicting stroke aetiology.MethodsIn a prospectively enrolled cohort we measured BNP and s-cTnI levels upon admission. Primary endpoints were mortality, unfavorable functional outcome and stroke recurrence after 90 days and after 12 months. Secondary endpoint was cardioembolic aetiology.ResultsIn 441 patients BNP but not s-cTnI remained an independent predictor for death with an adjusted HR of 1.2 (95% CI 1.1–1.4) after 90 days and 1.2 (95% CI 1.0–1.3) after one year. The comparison of the Area under Receiver Operating Characteristic (AUROC) of model A (age, NIHSS) and model B (age, NIHSS, BNP) showed an improvement in the prediction of mortality (0.85 (95% CI 0.79–0.90) vs. 0.86 (95% CI 0.81–0.92), Log Rank p = 0.004). Furthermore the category free net reclassification improvement (cfNRI) when adding BNP to the multivariate model was 57.5%, p<0.0001. For the prediction of functional outcome or stroke recurrence both markers provided no incremental value. Adding BNP to a model including age, atrial fibrillation and heart failure lead to a higher discriminatory accuracy for identification of cardioembolic stroke than the model without BNP (AUC 0.75 (95% CI 0.70–0.80) vs. AUC 0.79, (95% CI 0.75–0.84), p = 0.008).ConclusionBNP is an independent prognostic maker for overall mortality in patients with ischemic stroke or TIA and may improve the diagnostic accuracy to identify cardioembolic aetiology.Trial RegistrationClinicalTrials.gov NCT00390962

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Section: Discussionsupporting

confidence: 79%

BNP but Not s-cTnln Is Associated with Cardioembolic Aetiology and Predicts Short and Long Term Prognosis after Cerebrovascular Events

et al. 2014

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“…Despite the great interest in soluble ST2, GDF-15 and hsTn in coronary heart disease, 23,24 heart failure, 25-28 and ischemic stroke, 29,30 and in the general population where concentrations of each have been shown to predict future heart failure, coronary heart disease, and mortality, 8,31-33 only sparse data are available relating these biomarkers to risk of incident AF. To date, contradictory results have been published regarding the value of elevated TnI levels to predict AF in the post-operative setting after coronary artery bypass graft surgery.…”

Section: Discussionmentioning

confidence: 99%

Relation between soluble ST2, growth differentiation factor–15, and high-sensitivity troponin I and incident atrial fibrillation

Rienstra

Yin

Larson

et al. 2014

American Heart Journal

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Background We investigated whether circulating concentrations of soluble ST2, growth differentiation factor-15 (GDF-15), and high-sensitivity troponin I (hsTnI) are associated with incident atrial fibrillation (AF), and whether these biomarkers, improve current risk prediction models including AF risk factors, B-type natriuretic peptide (BNP) and C-reactive protein (CRP). Methods We studied the relation between soluble ST2, GDF-15, and hsTnI and development of AF in Framingham Heart Study participants without prevalent AF. We used Cox proportional hazard regression analysis to examine the relation of incident AF during a 10-year follow-up period with each biomarker. We adjusted for standard AF clinical risk factors, BNP, and CRP. Results The mean age of the 3,217 participants was 59±10 years and 54% were women. During 10 years of follow-up, 242 participants developed AF. In age- and sex-adjusted models, GDF-15 and hsTnI were associated with risk of incident AF; however, after including the AF risk factors and BNP and CRP, only hsTnI was significantly associated with AF (hazard ratio per 1 standard deviation of loge hsTnI, 1.12; 95%CI, 1.00-1.26; P=0.045). The C-statistic of the base model including AF risk factors, BNP and CRP was 0.803 (95% CI 0.777–0.830), and did not improve by adding individual or all 3 biomarkers. None of the discrimination and reclassification statistics was significant compared to the base model. Conclusion In a community-based cohort, circulating hsTnI concentrations were associated with incident AF. None of the novel biomarkers evaluated improved AF risk discrimination or reclassification beyond standard clinical AF risk factors and biomarkers.

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“…In addition, the sensitivity of troponin assays has continued to improve over time, such that the group of troponin-positive patients has become larger and more diverse over time [21,22] . One analysis by Jensen et al [13] found that one-third of stroke patients who tested negative for troponin would be considered troponin-positive when a highly-sensitive assay was used several years later. Despite these differences, a systematic review of 15 studies including 2,901 patients with ischemic stroke found that 18% of these individuals had an elevated troponin level during the stroke hospitalization [11] , a number remarkably similar to the 17% of patients with abnormal troponin values in our study.…”

Section: Prior Troponin Studiesmentioning

confidence: 99%

“…Despite relatively consistent literature suggesting a relationship between troponin elevation and mortality [8][9][10][11][12] , some authors have suggested that risk was related to patient age, stroke severity, electrocardiographic changes, and the presence of comorbid conditions [13] . These analyses were generally based on smaller, frequently European cohorts with more homogeneous patient populations and variable clinical management protocols [8-15, 17, 20-23] .…”

Section: Prior Troponin Studiesmentioning

confidence: 99%

Ischemic Stroke with Troponin Elevation: Patient Characteristics, Resource Utilization, and In-Hospital Outcomes

et al. 2016

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Background: Among patients hospitalized for acute ischemic stroke, abnormal serum troponins are associated with higher risk of short-term mortality. However, most findings have been reported from European hospitals. Whether troponin elevation after stroke is independently associated with death among a more heterogeneous US population remains unclear. Furthermore, only a few studies have evaluated the association between the magnitude of troponin elevation and subsequent mortality, patterns of dynamic troponin changes over time, or whether troponin elevation is related to specific causes of death. Methods: Using data collected in the American Heart Association's ‘Get With The Guidelines' stroke registry between 2008 and 2012 at a tertiary care US hospital, we used logistic regression to evaluate the independent relationship between troponin elevation and mortality after adjusting for demographic and clinical characteristics. We then assessed whether the magnitude of troponin elevation was related to in-hospital mortality by calculating mortality rates according to tertiles of peak troponin levels. Dynamic troponin changes over time were evaluated as well. To better understand whether troponin elevation identified patients most likely to die due to a specific cause of death, investigators blinded from troponin values reviewed all in-hospital deaths, and the association between troponin elevation and mortality was evaluated among patients with cardiac, neurologic, or other causes of death. Results: Of 1,145 ischemic stroke patients, 199 (17%) had elevated troponin levels. Troponin-positive patients had more cardiovascular risk factors, more intensive medical therapy, and greater use of cardiac procedures. These individuals had higher in-hospital mortality rates than troponin-negative patients (27 vs. 8%, p < 0.001), and this association persisted after adjustment for 13 clinical and management variables (OR 4.28, 95% CI 2.40-7.63). Any troponin elevation was associated with higher mortality, even at very low peak troponin levels (mortality rates 24-29% across tertiles of troponin). Patients with persistently rising troponin levels had fewer anticoagulant and antiatherosclerotic therapies, with markedly worse outcomes. Furthermore, troponin-positive patients had higher rates of all categories of death: neurologic (17 vs. 7%), cardiac (5 vs. <1%), and other causes of death (5 vs. <1%; p < 0.001 for all comparisons). Conclusions: Ischemic stroke patients with abnormal troponin levels are at higher risk of in-hospital death, even after accounting for demographic and clinical characteristics, and any degree of troponin elevation identifies this higher level of risk. Troponins that continue to rise during the hospitalization identify stroke patients at markedly higher risk of mortality, and both neurologic and non-neurologically mediated mortality rates are higher when troponin is elevated.

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Highly Sensitive Troponin T in Patients with Acute Ischemic Stroke

Cited by 35 publications

References 62 publications

BNP but Not s-cTnln Is Associated with Cardioembolic Aetiology and Predicts Short and Long Term Prognosis after Cerebrovascular Events

BNP but Not s-cTnln Is Associated with Cardioembolic Aetiology and Predicts Short and Long Term Prognosis after Cerebrovascular Events

Relation between soluble ST2, growth differentiation factor–15, and high-sensitivity troponin I and incident atrial fibrillation

Ischemic Stroke with Troponin Elevation: Patient Characteristics, Resource Utilization, and In-Hospital Outcomes

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