Troponin Levels in Patients in Acute Phase of Stroke

Main Article Content

Edyta Dziadkowiak*
Justyna Chojdak
Maciej Guziński
Katarzyna Lewczuk
Leszek Noga
Alicja Kostecka
Bogusław Paradowski

Abstract

Background and Purpose: The purpose of this study was to assess the correlation of cTn levels in the acute phase of ischemic stroke with the extent of stroke, the degree of disability assessed on the modified Rankin Scale, and their prognostic significance.


Methods: Patients were divided into 3 groups: (A) ischemic strokes, (B) ischemic strokes followed by hemorrhagic transformation, and (C) hemorrhagic strokes, excluding patients with symptoms of acute coronary syndrome. Cardiac troponin levels (cTn) were determined by venipuncture using the Abbott ARCHITECT STAT hs Troponin-I assay.


Results: Seventy-four percent of the patients (128/173) were diagnosed with ischemic stroke, 14% (24/173) with ischemic stroke followed by hemorrhagic transformation, and 12% (21/173) with hemorrhagic stroke. The mean troponin level was 0.21 ± 1.15 ng/mL in the whole group (from 0 up to 12.4 ng/mL), while in the group with ischemic stroke the mean troponin level was 0.15 ± 076 ng/mL (from 0 up to 7.9 ng/mL). In 79/128 patients with ischemic stroke, troponin values were normal. Troponin levels were significantly correlated with the modified Rankin Scale on admission and on the day of discharge (p = 0.0001). Hyperlipidemia present in 104 patients had a statistically significant effect on statistically higher troponin levels (0.15 ± 0.80 ng/mL). In 48% of the cases, vascular lesions involved the vascular area of the middle cerebral artery (83 patients), while the rarest ones were in the basal ganglia area (4 patients). In the case of cerebellum changes, statistically significantly lower troponin levels were found than in the other groups (p = 0.050).


Conclusions: A moderate increase in troponin was observed in patients with cerebral stroke. Elevated troponin levels indicated the lesion size and correlated with the degree of disability. High troponin levels can be a prognostic factor in the course of stroke.

Downloads

Download data is not yet available.

Article Details

Dziadkowiak, E., Chojdak, J., Guziński, M., Lewczuk, K., Noga, L., Kostecka, A., & Paradowski, B. (2018). Troponin Levels in Patients in Acute Phase of Stroke. Journal of Cardiovascular Medicine and Cardiology, 5(4), 053–058. https://doi.org/10.17352/2455-2976.000072
Research Article(s)

Copyright (c) 2018 Dziadkowiak E, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Licensing and protecting the author rights is the central aim and core of the publishing business. Peertechz dedicates itself in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. Peertechz licensing terms are formulated to facilitate reuse of the manuscripts published in journals to take maximum advantage of Open Access publication and for the purpose of disseminating knowledge.

We support 'libre' open access, which defines Open Access in true terms as free of charge online access along with usage rights. The usage rights are granted through the use of specific Creative Commons license.

Peertechz accomplice with- [CC BY 4.0]

Explanation

'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.

With this license, the authors are allowed that after publishing with Peertechz, they can share their research by posting a free draft copy of their article to any repository or website.
'CC BY' license observance:

License Name

Permission to read and download

Permission to display in a repository

Permission to translate

Commercial uses of manuscript

CC BY 4.0

Yes

Yes

Yes

Yes

The authors please note that Creative Commons license is focused on making creative works available for discovery and reuse. Creative Commons licenses provide an alternative to standard copyrights, allowing authors to specify ways that their works can be used without having to grant permission for each individual request. Others who want to reserve all of their rights under copyright law should not use CC licenses.

Tesson A, Abdo R, Kamath A, Sutter J, Cline R, et al. (2018) HEART failure? Episodes of missed major cardiac events when applying the HEART pathway to an observation unit population. Crit Pathw Cardiol 17: 88-94. Link: https://goo.gl/TVcn7Y

Noorvash D, Ramos R, Hatch L, Muck A, Olson AS (2018) Assessment of the utility of ordering a troponin in low- and intermediate-risk patients presenting to the Emergency Department with supraventricular tachycardia: A retrospective chart review. J Emerg Med 55: 1-6. Link: https://goo.gl/v9mAjL

Hedberg P, Valkama J, Suvanto E, Pikkujämsä S, Ylitalo K (2006) Evaluation of innotrac aio! Second-generation cardiac troponin I assay: the main characteristics for routine clinical use. J Autom Methods Manag Chem 2006: 39325. Link: https://goo.gl/rqTxC6

Bellan M, Pirisi M, Bellomo G, Sainaghi PP (2017) A case of false positive Troponin I in a patient affected by cryoglobulinemic vasculitis. Reumatismo 69: 40-42. Link: https://goo.gl/MN75mi

Batal O, Jentzer J, Balaney B, Kolia N, Hickey G, et al. (2016) The prognostic significance of troponin I elevation in acute ischemic stroke. Journal of Critical Care 31: 41-47. Link: https://goo.gl/CLGVT2

Abdi S, Oveis-Gharan S, Sinaei F, Ghorbani A (2015) Elevated troponin T after acute ischemic stroke: Association with severity and location of infarction. Iran J Neurol 14: 35-40. Link: https://goo.gl/i6R1HU

Mochmann HC, Scheitz JF, Petzold GC, Haeusler KG, Audebert HJ, et al. (2016) Coronary angiographic findings in acute ischemic stroke patients with elevated cardiac troponin: The troponin elevation in acute ischemic stroke (TRELAS) study. Circulation 133: 1264-1271. Link: https://goo.gl/TFBty7

VanHouten J, Fricker G, Collins B, Bhatia R, Ellis C, et al. (2018) Circulating troponin I level in patients with acute ischemic stroke. Curr Neurol Neurosci Rep 18: 32. Link: https://goo.gl/21CLNL

Willeit P, Welsh P, Evans JDW, Tschiderer L, Boachie C, et al. (2017) High-sensitivity cardiac troponin concentration and risk of first-ever cardiovascular outcomes in 154,052 participants. J Am Coll Cardiol 70: 558-568. Link: https://goo.gl/N8N35Y

Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, et al. (2013) An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44: 2064-2089. Link: https://goo.gl/tSr3vL

Dijkland SA, Voormolen DC, Venema E, Roozenbeek B, Polinder S, et al. (2018) Utility-weighted modified Rankin Scale as primary outcome in stroke trials: A simulation study. Stroke 49: 965–971. Link: https://goo.gl/CTaQYU

Chaisinanunkul N, Adeoye O, Lewis RJ, Grotta JC, Broderick J, et al. (2015) Adopting a patient-centered approach to primary outcome analysis of acute stroke trials using a utility-weighted modified Rankin Scale. Stroke 46: 2238-2243. Link: https://goo.gl/ZYJVWW

Lasek-Bal A, Kowalewska-Twardela T, Gąsior Z, Warsz-Wianecka A, Haberka M, et al. (2014) The significance of troponin elevation for the clinical course and outcome of first-ever ischaemic stroke. Cerebrovasc Dis 38: 212-218. Link: https://goo.gl/wYsZfd

Scheitz J, Mochmann HC, Erdur H, Tütüncü S, Haeusler KG, et al. (2014) Prognostic relevance of cardiac troponin T levels and their dynamic changes measured with a high-sensitivity assay in acute ischaemic stroke: Analyses from the TRELAS cohort. Int J Cardiol 177: 886-893. Link: https://goo.gl/q3p6Zf

Budincevic H, Sremec J, Crnac P, Ostojic V, Galic E, et al. (2017) Impact of troponin I on outcome of ischemic stroke patients. Rom J Intern Med 55: 19-22. Link: https://goo.gl/XzHehs

Thalin C, Rudberg AS, Johansson F, Jonsson F, Laska AC, et al. (2015) Elevated troponin levels in acute stroke patients predict long-term mortality. J Stroke Cerebrovasc Dis 24: 2390-2396. Link: https://goo.gl/ugYBts

Song HS (2008) Cardiac troponin T elevation after stroke: relationships between elevated serum troponin T, stroke location, and prognosis. J Clin Neurol 4: 75-83. Link: https://goo.gl/mgAqjw

Hasirci B, Okay M, Agircan D, Kocer A (2013) Elevated troponin level with negative outcome was found in ischemic stroke. Cardiovasc Psychiatry Neurol 2013: 953672. Link: https://goo.gl/3a4HtJ

Rincon F, Dhamoon M, Moon Y, Paik MC, Boden-Albala B, et al. (2008) Stroke location and association with fatal cardiac outcomes: Northern Manhattan Study (NOMAS). Stroke 39: 2425–2431. Link: https://goo.gl/fTyHJv

Oppenheimer SM, Kedem G, Martin WM (1996) Left-insular cortex lesions perturb cardiac autonomic tone in humans. Clin Auton Res 6: 131–140. Link: https://goo.gl/cvMZSf

Laowattana S, Zeger SL, Lima JA, Goodman SN, Wittstein IS, et al. (2006) Left insular stroke is associated with adverse cardiac outcome. Neurology 66: 477–483. Link: https://goo.gl/gKfrhS

Oppenheimer S, Hachinski V (1992) Complications of acute stroke. Lancet 339: 721–724. Link: https://goo.gl/zRQKmW

Scheitz JF, Mochmann HC, Nolte CH, Haeusler KG, Audebert HJ, et al. (2011) Troponin elevation in acute ischemic stroke (TRELAS)—protocol of a prospective observational trial. BMC Neurol 11: 98. Link: https://goo.gl/PthSBW

Su YC, Huang KF, Yang FY, Lin SK (2016) Elevation of troponin I in acute ischemic stroke. Peer J 4: e1866. Link: https://goo.gl/MTLY5y

Dous G, Grigos A, Grodman R (2017) Elevated troponin in patients with acute stroke—is it a true heart attack? Egypt Heart J 69: 165-170. Link: https://goo.gl/GzBiFT

Yoon M, Yang PS, Jang E, Yu HT, Kim TH, et al. (2018) Dynamic changes of cha2ds2-vasc score and the risk of ischaemic stroke in Asian patients with atrial fibrillation: A nationwide cohort study. Thromb Haemost 18: 1296-1304. Link: https://goo.gl/1A8p4s

Johnston KC, Li JY, Lyden PD, Hanson SK, Feasby TE, et al. (1998) Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. Stroke 29: 447-453. Link: https://goo.gl/UUdCYa

Christensen H, Boysen G, Christensen AF, Johannesen HH (2005) Insular lesions, ECG abnormalities, and outcome in acute stroke. J Neurol Neurosurg Psychiatry 76: 269–271. Link: https://goo.gl/qRc8Hq

Ripoll JG, Blackshear JL, Díaz-Gómez JL (2018) Acute Cardiac Complications in Critical Brain Disease. Neurosurg Clin N Am 29: 281-297. Link: https://goo.gl/P7jGwq

Biso S, Wongrakpanich S, Agrawal A, Yadlapati S, Kishlyansky M, et al. (2017) A review of neurogenic stunned myocardium. Cardiovasc Psychiatry Neurol 2017: 5842182. Link: https://goo.gl/gVUVog

Mierzewska-Schmidt M, Gawecka A (2015) Neurogenic stunned myocardium—do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure? Anaesthesiol Intensive Ther 47: 175-180. Link: https://goo.gl/SqdTX7

Murthy SB, Shah S, Venkatasubba Rao CP, Suarez JI, Bershad EM (2014) Clinical characteristics of myocardial stunning in acute stroke. J Clin Neurosci 21: 1279-1282. Link: https://goo.gl/ULKCKR