Shadi Yaghi1, Andrew D Chang2, Brittany A Ricci2, Mahesh V Jayaraman2, Ryan A McTaggart2, Morgan Hemendinger2, Priya Narwal2, Katarina Dakay2, Brian Mac Grory2, Shawna M Cutting2, Tina M Burton2, Christopher Song2, Emile Mehanna2, Matthew Siket2, Tracy E Madsen2, Michael Reznik2, Alexander E Merkler2, Michael P Lerario2, Hooman Kamel2, Mitchell S V Elkind2, Karen L Furie2. 1. From the Department of Neurology (S.Y., A.D.C., B.A.R., M.H., P.N., K.D., B.M., S.M.C., T.M.B., M.R., K.L.F.), Department of Neurosurgery (M.V.J., R.A.M.), Department of Diagnostic Imaging (M.V.J., R.A.M.), Department of Internal Medicine, Division of Cardiovascular Medicine (C.S., E.M.), and Department of Emergency Medicine (M.S., T.E.M.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Neurology (A.E.M., M.P.L., H.K.) and Feil Family Brain and Mind Research Institute (A.E.M., M.P.L., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology, College of Physicians and Surgeons (M.S.V.E.) and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY. shadiyaghi@yahoo.com. 2. From the Department of Neurology (S.Y., A.D.C., B.A.R., M.H., P.N., K.D., B.M., S.M.C., T.M.B., M.R., K.L.F.), Department of Neurosurgery (M.V.J., R.A.M.), Department of Diagnostic Imaging (M.V.J., R.A.M.), Department of Internal Medicine, Division of Cardiovascular Medicine (C.S., E.M.), and Department of Emergency Medicine (M.S., T.E.M.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Neurology (A.E.M., M.P.L., H.K.) and Feil Family Brain and Mind Research Institute (A.E.M., M.P.L., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology, College of Physicians and Surgeons (M.S.V.E.) and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY.
Abstract
BACKGROUND AND PURPOSE: Elevated cardiac troponin is a marker of cardiac disease and has been recently shown to be associated with embolic stroke risk. We hypothesize that early elevated troponin levels in the acute stroke setting are more prevalent in patients with embolic stroke subtypes (cardioembolic and embolic stroke of unknown source) as opposed to noncardioembolic subtypes (large-vessel disease, small-vessel disease, and other). METHODS: We abstracted data from our prospective ischemic stroke database and included all patients with ischemic stroke during an 18-month period. Per our laboratory, we defined positive troponin as ≥0.1 ng/mL and intermediate as ≥0.06 ng/mL and <0.1 ng/mL. Unadjusted and adjusted regression models were built to determine the association between stroke subtype (embolic stroke of unknown source and cardioembolic subtypes) and positive and intermediate troponin levels, adjusting for key confounders, including demographics (age and sex), clinical characteristics (hypertension, hyperlipidemia, diabetes mellitus, renal function, coronary heart disease, congestive heart failure, current smoking, and National Institutes of Health Stroke Scale score), cardiac variables (left atrial diameter, wall-motion abnormalities, ejection fraction, and PR interval on ECG), and insular involvement of infarct. RESULTS: We identified 1234 patients, of whom 1129 had admission troponin levels available; 10.0% (113/1129) of these had a positive troponin. In fully adjusted models, there was an association between troponin positivity and embolic stroke of unknown source subtype (adjusted odds ratio, 4.46; 95% confidence interval, 1.03-7.97; P=0.003) and cardioembolic stroke subtype (odds ratio, 5.00; 95% confidence interval, 1.83-13.63; P=0.002). CONCLUSIONS: We found that early positive troponin after ischemic stroke may be independently associated with a cardiac embolic source. Future studies are needed to confirm our findings using high-sensitivity troponin assays and to test optimal secondary prevention strategies in patients with embolic stroke of unknown source and positive troponin.
BACKGROUND AND PURPOSE: Elevated cardiac troponin is a marker of cardiac disease and has been recently shown to be associated with embolic stroke risk. We hypothesize that early elevated troponin levels in the acute stroke setting are more prevalent in patients with embolic stroke subtypes (cardioembolic and embolic stroke of unknown source) as opposed to noncardioembolic subtypes (large-vessel disease, small-vessel disease, and other). METHODS: We abstracted data from our prospective ischemic stroke database and included all patients with ischemic stroke during an 18-month period. Per our laboratory, we defined positive troponin as ≥0.1 ng/mL and intermediate as ≥0.06 ng/mL and <0.1 ng/mL. Unadjusted and adjusted regression models were built to determine the association between stroke subtype (embolic stroke of unknown source and cardioembolic subtypes) and positive and intermediate troponin levels, adjusting for key confounders, including demographics (age and sex), clinical characteristics (hypertension, hyperlipidemia, diabetes mellitus, renal function, coronary heart disease, congestive heart failure, current smoking, and National Institutes of Health Stroke Scale score), cardiac variables (left atrial diameter, wall-motion abnormalities, ejection fraction, and PR interval on ECG), and insular involvement of infarct. RESULTS: We identified 1234 patients, of whom 1129 had admission troponin levels available; 10.0% (113/1129) of these had a positive troponin. In fully adjusted models, there was an association between troponin positivity and embolic stroke of unknown source subtype (adjusted odds ratio, 4.46; 95% confidence interval, 1.03-7.97; P=0.003) and cardioembolic stroke subtype (odds ratio, 5.00; 95% confidence interval, 1.83-13.63; P=0.002). CONCLUSIONS: We found that early positive troponin after ischemic stroke may be independently associated with a cardiac embolic source. Future studies are needed to confirm our findings using high-sensitivity troponin assays and to test optimal secondary prevention strategies in patients with embolic stroke of unknown source and positive troponin.
Authors: Kevin Jordan; Shadi Yaghi; Athena Poppas; Andrew D Chang; Brian Mac Grory; Shawna Cutting; Tina Burton; Mahesh Jayaraman; Georgios Tsivgoulis; M Khaled Sabeh; Alexander E Merkler; Hooman Kamel; Mitchell S V Elkind; Karen Furie; Christopher Song Journal: Stroke Date: 2019-06-13 Impact factor: 7.914
Authors: Shadi Yaghi; Andrew D Chang; Shawna Cutting; Mahesh Jayaraman; Ryan A McTaggart; Brittany A Ricci; Katarina Dakay; Priya Narwal; Brian Mac Grory; Tina Burton; Michael Reznik; Brian Silver; Ajay Gupta; Christopher Song; Emile Mehanna; Matthew Siket; Michael P Lerario; Daniel C Saccetti; Alexander E Merkler; Hooman Kamel; Mitchell S V Elkind; Karen Furie Journal: Stroke Date: 2018-11 Impact factor: 7.914