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

Abstract

Background: Hemorrhagic transformation (HT) is a common complication of intravenous thrombolysis with alteplase. Cardiac troponin has been found to be associated with poor prognosis and cognitive impairment in acute ischemic stroke. But studies on the relationship between troponin and HT after thrombolysis are scarce.Methods: This study retrospectively analyzed thrombolytic patients from June 2015 to June 2021 in the Second Affiliated Hospital of Wenzhou Medical University. Cardiac troponin I were measured on admission and on following days to determine the presence of elevation and dynamic changes. HT within 24–36 h after treatment was identified by cranial computed tomography (CT). Besides, a score on the modified Rankin Scale (mRS) > 2 at discharge was defined as unfavorable outcome. Univariate analysis was used to explore the factors related to the troponin elevation on admission and troponin dynamic changes. Multivariate logistic regression model was used to investigated the association between troponin elevation on admission, troponin dynamic changes and HT after thrombolysis, respectively.Results: Troponin levels on admission were measured in 377 patients, and follow-up assay was performed in 292 patients (77.5%). 39 patients (10.3%) had troponin elevation on admission, and 66 patients (22.6%) had troponin dynamic changes comprising rising and falling pattern. The pre-existing heart disease, renal insufficiency and higher stroke severity are related to both troponin elevation on admission and the subsequent troponin dynamic changes. After adjusting the potential confounding factors, logistic regression model showed that patients with troponin elevation on admission had insignificant trend to develop HT (OR 2.23, 95%CI 0.96–5.21, p = 0.063), while patients with troponin dynamic changes had significantly higher risk of HT (OR 2.27, 95%CI 1.06–4.85, p = 0.034). Compared to the troponin elevation, a statistically stronger association was present between rising troponin dynamic changes and unfavorable outcome (OR 2.20, 95%CI 1.05–4.60, p = 0.037).Conclusion: Troponin dynamic changes are associated with HT after thrombolysis. Serial measurements are quite necessary in thrombolytic patients with risk factors associated with troponin dynamic changes (e.g., advanced age, pre-existing heart disease, higher NIHSS score, and troponin elevation on admission).

Impact of high-sensitivity troponin elevation and dynamic changes on 90-day mortality in patients with acute ischemic stroke after mechanical thrombectomy: results from an observational cohort

“…A study showed that cTnI dynamic changes had a more robust statistical association with hemorrhagic transformation after thrombolysis in patients with AIS than troponin elevation. 27 However, in patients with AIS after MT, we did not observe an association between troponin elevation and troponin dynamic changes with sICH and a study of hs-cTnT showed similar results. 20 Further studies on the mechanism of hs-cTnI dynamic change in predicting the 90-day mortality in patients with AIS after MT are warranted.…”

Cardiovascular biomarkers: exploring troponin and BNP applications in conditions related to carbon monoxide exposure

“…Proposed processes include CO-induced hypoxia producing cardiomyocyte necrosis [ 34 , 35 ], oxidative stress activating proteases [ 36 , 37 ], and apoptosis inducing membrane blebs with cTn release [ 38 – 40 ]. The degree of exposure, length of time, underlying heart condition, and measurement time all affect troponin elevation patterns [ 17 , 21 , 41 ]. Research indicates that peak troponin levels occur 24 h after CO exposure, which helps with both short- and long-term outcome prediction [ 42 ].…”