Jan F Scheitz1, Hans-C Mochmann2, Hebun Erdur3, Serdar Tütüncü3, Karl Georg Haeusler4, Ulrike Grittner5, Ulrich Laufs6, Matthias Endres7, Christian H Nolte4. 1. Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Excellence Cluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: jan-friedrich.scheitz@charite.de. 2. Medizinische Klinik für Kardiologie und Pulmologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. 3. Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. 4. Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. 5. Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department for Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany. 6. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany. 7. Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Excellence Cluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Charité - Universitätsmedizin Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Charité - Universitätsmedizin Berlin, Germany.
Abstract
BACKGROUND/ OBJECTIVES: To assess the prognostic relevance of cardiac troponin T (cTnT) values and their serial changes as measured with a high-sensitivity assay in acute ischaemic stroke. METHODS AND RESULTS: In total, 1016 consecutive acute ischaemic stroke patients were registered prospectively within a two-year period. High-sensitivity cTnT was quantitated on admission and the following day. Patients were stratified into three groups: below the 99 th percentile of a healthy reference population (< 14 ng/l; n = 409), moderately elevated cTnT (below the median of remaining patients, 14-30 ng/l; n=299) and high cTnT (> 30 ng/l; n = 308). Outcome measures were unfavourable outcome (modified Rankin Scale ≥ 2 at hospital discharge, n=604) and in-hospital mortality (n = 36). Peak cTnT levels were significantly associated with unfavourable outcome (adjusted odds ratios versus reference for moderately elevated cTnT 1.7, 95% confidence interval [CI] 1.1-2.7 and for high cTnT 3.1, 95% CI 1.8-5.6). The optimal cut-off for determining unfavourable outcome proved to be 16 ng/l. Adding this cut-off to clinical variables led to a significant improvement of c-statistics (0.851 versus 0.838, p=0.02). Dynamic changes (δ ≥ 50%) of cTnT were detected in 137 patients (13%). Multiple Cox regression analysis showed an independent association of dynamic changes in cTnT with in-hospital mortality (hazard ratio 2.3, 95% CI 1.1-4.7). The model-fitting (p<0.001) and c-statistics (0.889 versus 0.863, p = 0.08) improved most after dynamic change in cTnT had been added to a regression model which included clinical variables alone. CONCLUSIONS: Our study adds novel findings relevant for interpretation of highly sensitive cTnT assays in acute ischaemic stroke: a) Myocardial injury is detectable in more than half of patients; b) even moderately elevated cTnT is associated with unfavourable outcome (optimal cut-off 16 ng/l); and c) dynamic changes in cTnT indicate an increased risk of in-hospital death.
BACKGROUND/ OBJECTIVES: To assess the prognostic relevance of cardiac troponin T (cTnT) values and their serial changes as measured with a high-sensitivity assay in acute ischaemic stroke. METHODS AND RESULTS: In total, 1016 consecutive acute ischaemic strokepatients were registered prospectively within a two-year period. High-sensitivity cTnT was quantitated on admission and the following day. Patients were stratified into three groups: below the 99 th percentile of a healthy reference population (< 14 ng/l; n = 409), moderately elevated cTnT (below the median of remaining patients, 14-30 ng/l; n=299) and high cTnT (> 30 ng/l; n = 308). Outcome measures were unfavourable outcome (modified Rankin Scale ≥ 2 at hospital discharge, n=604) and in-hospital mortality (n = 36). Peak cTnT levels were significantly associated with unfavourable outcome (adjusted odds ratios versus reference for moderately elevated cTnT 1.7, 95% confidence interval [CI] 1.1-2.7 and for high cTnT 3.1, 95% CI 1.8-5.6). The optimal cut-off for determining unfavourable outcome proved to be 16 ng/l. Adding this cut-off to clinical variables led to a significant improvement of c-statistics (0.851 versus 0.838, p=0.02). Dynamic changes (δ ≥ 50%) of cTnT were detected in 137 patients (13%). Multiple Cox regression analysis showed an independent association of dynamic changes in cTnT with in-hospital mortality (hazard ratio 2.3, 95% CI 1.1-4.7). The model-fitting (p<0.001) and c-statistics (0.889 versus 0.863, p = 0.08) improved most after dynamic change in cTnT had been added to a regression model which included clinical variables alone. CONCLUSIONS: Our study adds novel findings relevant for interpretation of highly sensitive cTnT assays in acute ischaemic stroke: a) Myocardial injury is detectable in more than half of patients; b) even moderately elevated cTnT is associated with unfavourable outcome (optimal cut-off 16 ng/l); and c) dynamic changes in cTnT indicate an increased risk of in-hospital death.
Authors: Dirk Westermann; Johannes Tobias Neumann; Nils Arne Sörensen; Stefan Blankenberg Journal: Nat Rev Cardiol Date: 2017-04-06 Impact factor: 32.419
Authors: Peter Wrigley; Jane Khoury; Bryan Eckerle; Kathleen Alwell; Charles J Moomaw; Daniel Woo; Mathew L Flaherty; Felipe De Los Rios la Rosa; Jason Mackey; Opeolu Adeoye; Sharyl Martini; Simona Ferioli; Brett M Kissela; Dawn O Kleindorfer Journal: Stroke Date: 2017-04-05 Impact factor: 7.914
Authors: M Kruska; C Fastner; J F Scheitz; A Kolb; M Rutsch; T Papavassiliu; M Borggrefe; A Alonso; I Akin; K Szabo; S Baumann Journal: Herz Date: 2020-07-06 Impact factor: 1.443