Atrial fibrillation, elevated troponin, ischemic stroke and adverse outcomes: understanding the connection.

Cardiac troponin is widely used for the diagnosis of acute myocardial infarction. In addition to this indication, the elevation of troponin has been found to play a prognostic role in ischemic stroke. It is hypothesized that approximately 15-20 % of all ischemic strokes are associated with atrial fibrillation and that these events are more often fatal. Recent studies have demonstrated that troponin elevation can also be used as a prognosticator in patients with atrial fibrillation and for risk stratification to predict which patients are more prone to stroke or other thromboembolic events. Therefore, troponin appears to play a pivotal role in the overlap of atrial fibrillation and ischemic stroke and the subsequent development of an adverse outcome. The different aspects of this association will be addressed and novel explanations will be proposed to better clarify the underlying mechanisms.