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Open Access Research article

Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke

Kashif Waqar Faiz12*, Bente Thommessen2, Gunnar Einvik13, Pål Haugar Brekke13, Torbjørn Omland13 and Ole Morten Rønning12

Author Affiliations

1 Institute of Clinical Medicine, University of Oslo, Oslo, Norway

2 Department of Neurology, Division of Medicine, Akershus University Hospital, Lørenskog N-1478, Norway

3 Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway

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BMC Neurology 2014, 14:96  doi:10.1186/1471-2377-14-96

Published: 3 May 2014

Abstract

Background

A proportion of patients with acute ischemic stroke have elevated cardiac troponin levels and ECG changes suggestive of cardiac injury, but the etiology is unclear. The aims of this study were to assess the frequency of high sensitivity cardiac troponin T (hs-cTnT) elevation, to identify determinants and ECG changes associated with hs-cTnT elevation, to identify patients with myocardial ischemia and to assess the impact of hs-cTnT elevation on in-hospital mortality.

Methods

Patients discharged with a diagnosis of acute ischemic stroke during a 1-year period, were included. Patients diagnosed with acute myocardial infarction (MI) within the last 7 days before admission or during hospitalization were excluded.

Results

In all, 156 (54.4%) of 287 patients had elevated hs-cTnT. The factors independently associated with hs-cTnT elevation were age ≥ 76 years (OR 3.71 [95% CI 2.04-6.75]), previous coronary heart disease (CHD) (OR 2.61 [1.23-5.53]), congestive heart failure (OR 4.26 [1.15-15.82]), diabetes mellitus (OR 4.02 [1.50-10.76]) and lower eGFR (OR 0.97 [0.95-0.98]). Of the 182 patients who had two hs-cTnT measurements, 12 (6.6%) had both a rise or fall of hs-cTnT with at least one elevated value, and ECG manifestations of myocardial ischemia, e.g. meeting the criteria of acute MI. Both dynamic relative change (p = 0.026) and absolute change (p = 0.032) in hs-cTnT were significantly associated with higher in-hospital mortality.

Conclusions

Established CHD and cardiovascular risk factors are associated with hs-cTnT elevation. Acute MI is likely underdiagnosed in acute ischemic stroke patients. Dynamic changes in troponin levels seem to be related to poor short-term prognosis.

Keywords:
High sensitivity cardiac troponin T; Acute ischemic stroke; ECG