Myocardial injury in transient global amnesia: a case‐control study

Abstract

Background and purpose Elevation of cardiac troponin (cTn), a sensitive biomarker of myocardial injury, is frequently observed in severe acute neurological disorders. Case reports suggest that cardiac dysfunction may also occur in patients with transient global amnesia (TGA). Until now, no study has systematically assessed this phenomenon. Methods We performed a case‐control study using data of consecutive patients presenting with TGA from 2010 to 2015. Multiple logistic regression analysis accounting for age, sex and cardiovascular risk factors was performed to compare the likelihood of myocardial injury [defined as elevation of cTn > 99th percentile (≥14 ng/L); highly sensitive cardiac troponin T assay] in TGA with three reference groups: migraine with aura, vestibular neuritis and transient ischaemic attack (TIA). Results Cardiac troponin elevation occurred in 28 (25%) of 113 patients with TGA. Patients with TGA with cTn elevation were significantly older, more likely to be female and had higher blood pressure on admission compared with those without. The likelihood of myocardial injury following TGA was at least more than twofold higher compared with all three reference groups [adjusted odds ratio, 5.5; 95% confidence interval (CI), 1.2–26.4, compared with migraine with aura; adjusted odds ratio, 2.2; 95% CI, 1.2–4.4, compared with vestibular neuritis; adjusted odds ratio, 2.3; 95% CI, 1.3–4.2, compared with TIA]. Conclusions One out of four patients with TGA had evidence of myocardial injury as assessed by highly sensitive cTn assays. The likelihood of myocardial injury associated with TGA was even higher than in TIA patients with a more pronounced cardiovascular risk profile. Our findings suggest the presence of a TGA‐related disturbance of brain–heart interaction that deserves further investigation.

Neurological update: use of cardiac troponin in patients with stroke

“…TGA is often preceded by an emotionally or physically stressful event leading to focal metabolic disturbance within the hippocampus, which is another region involved in the central autonomic control of the heart [ 44 ]. In two recent retrospective cohort studies, the prevalence of a cardiac involvement in TGA patients was investigated [ 45 , 46 ]. Approximately 25% of TGA patients presented with elevated hs-cTn levels.…”

“…Approximately 25% of TGA patients presented with elevated hs-cTn levels. After multivariable adjustment, the diagnosis of TGA was associated with a higher risk of hs-cTn elevation than diagnosis of transient ischemic attack (TIA), migraine with aura or acute vestibular syndrome [ 46 ]. Altogether, these correlations indicate that mechanisms similar to those described for the ‘Stroke-Heart syndrome’ are involved in the occurrence of myocardial injury after acute neurological conditions.…”

Increased incidence of transient global amnesia during the Covid-19 crisis?

“…For Takotsubo cardiomyopathy, that might share pathophysiological mechanisms with TGA [5,6], it has been reported that it can occur in the context of natural disasters like e. g. earthquakes [7]; the first cases in the context of Covid-19 have been published recently [8][9][10].…”

Frequency of silent brain infarction in transient global amnesia

“…Taking all together, intense emotional or physical stress as a frequent precipitating event with excessive sympathetic activation might elicit cardiac diastolic and/or systolic output dysfunction resulting in brain hypoperfusion compromising susceptible brain structures such as the hippocampus. This possible pathophysiology of TGA and ischemic amnesia is supported by a recently published report presenting evidence that the likelihood of myocardial injury in patients with TGA was twofold higher compared to patients with transient ischemic attack [9]. In another recent study nearly 9% of TGA patients had elevated levels of high sensitive troponine T, suggesting myocardial injury [10].…”