Neurological update: use of cardiac troponin in patients with stroke

Abstract

Cardiac troponin is a specific and sensitive biomarker to identify and quantify myocardial injury. Myocardial injury is frequently detected after acute ischemic stroke and strongly associated with unfavorable outcomes. Concomitant acute coronary syndrome is only one of several possible differential diagnoses that may cause elevation of cardiac troponin after stroke. As a result, there are uncertainties regarding the correct interpretation and optimal management of stroke patients with myocardial injury in clinical practice. Elevation of cardiac troponin may occur as part of a ‘Stroke-Heart Syndrome’. The term ‘Stroke-Heart Syndrome’ subsumes a clinical spectrum of cardiac complications after stroke including cardiac injury, dysfunction, and arrhythmia which may relate to disturbances of autonomic function and the brain–heart axis. In this review, we provide an up-to-date overview about prognostic implications, mechanisms, and management of elevated cardiac troponin levels in patients with acute ischemic stroke.

Troponin Elevation on Admission Along With Dynamic Changes and Their Association With Hemorrhagic Transformation After Thrombolysis

“…Chronic myocardial injury is mostly caused by pre-existing heart diseases; renal insufficiency also reflects coexisting serious heart diseases (Scheitz et al, 2021). In addition to the comorbid ACS, acute myocardial injury is usually owing to stroke-heart syndrome (Scheitz et al, 2018(Scheitz et al, , 2021.…”

“…Chronic myocardial injury is mostly caused by pre-existing heart diseases; renal insufficiency also reflects coexisting serious heart diseases (Scheitz et al, 2021). In addition to the comorbid ACS, acute myocardial injury is usually owing to stroke-heart syndrome (Scheitz et al, 2018(Scheitz et al, , 2021. Stroke-heart syndrome is in virtue of acute cerebral ischemia injury to the central autonomic network, which then leads to activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis.…”

“…Troponin elevation is common in patients with AIS, and causes of troponin elevation can be divided into acute myocardial injury and chronic myocardial injury based on whether dynamic changes are observed with serial troponin assays ( Scheitz et al, 2021 ). Unlike previous studies ( Anders et al, 2013 ; Scheitz et al, 2014 ), troponin dynamic changes accounted for a greater proportion of patients with elevated troponin levels in our study.…”

“…Cardiac troponins, a specific marker for myocardial injury, are recommended by the American Heart Association (AHA)/American Stroke Association (ASA) for routine detection in all patients with AIS ( Powers et al, 2019 ). Troponin elevation is frequently detected in AIS due to premorbid cardiac disease, comorbid acute coronary syndrome (ACS) and stroke–heart syndrome ( Scheitz et al, 2021 ). There is strong evidence that troponin elevation is associated with poor short- and long-term outcome ( Scheitz et al, 2012 , 2014 ; Ahn et al, 2017 ; Wrigley et al, 2017 ) and cognitive impairment ( Broersen et al, 2020 ).…”

Myocardial injury in acute ischemic stroke

“…If up-to-date, high-sensitivity assays are in use, elevated cTn will be detectable in about 30-60% of stroke patients. 17,18 Elevated cTn in AIS is more common in older patients. However, the prevalence of 30-60% is much higher than would be expected from populations of elderly individuals without acute stroke.…”