Prevalence of myocardial injury in patients after acute ischaemic stroke according to standard criteria
Status PubMed-not-MEDLINE Jazyk angličtina Země Anglie, Velká Británie Médium electronic-ecollection
Typ dokumentu časopisecké články
PubMed
37234232
PubMed Central
PMC10206909
DOI
10.1093/eurheartjsupp/suad104
PII: suad104
Knihovny.cz E-zdroje
- Klíčová slova
- Acute ischaemic stroke, Cardiovascular disease, Mortality, Myocardial injury, Stroke, Troponin,
- Publikační typ
- časopisecké články MeSH
This study examined the prevalence of acute and chronic myocardial injury according to standard criteria in patients after acute ischaemic stroke (AIS) and its relation to stroke severity and short-term prognosis. Between August 2020 and August 2022, 217 consecutive patients with AIS were enrolled. Plasma levels of high-sensitive cardiac troponin I (hs-cTnI) were measured in blood samples obtained at the time of admission and 24 and 48 h later. The patients were divided into three groups according to the Fourth Universal Definition of Myocardial Infarction: no injury, chronic injury, and acute injury. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later, and on the day of hospital discharge. A standard echocardiographic examination was performed within the first 7 days of hospitalization in patients with suspected abnormalities of left ventricular function and regional wall motion. Demographic characteristics, clinical data, functional outcomes, and all-cause mortality were compared between the three groups. The National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following hospital discharge were used to assess stroke severity and outcome. Elevated hs-cTnI levels were measured in 59 patients (27.2%): 34 patients (15.7%) had acute myocardial injury and 25 patients (11.5%) had chronic myocardial injury within the acute phase after ischaemic stroke. An unfavourable outcome, evaluated based on the mRS at 90 days, was associated with both acute and chronic myocardial injury. Myocardial injury was also strongly associated with all-cause death, with the strongest association in patients with acute myocardial injury, at 30 days and at 90 days. Kaplan-Meier survival curves showed that all-cause mortality was significantly higher in patients with acute and chronic myocardial injury than in patients without myocardial injury (P < 0.001). Stroke severity, evaluated with the NIHSS, was also associated with acute and chronic myocardial injury. A comparison of the ECG findings between patients with and without myocardial injury showed a higher occurrence in the former of T-wave inversion, ST segment depression, and QTc prolongation. In echocardiographic analysis, a new abnormality in regional wall motion of the left ventricle was identified in six patients. Chronic and acute myocardial injury with hs-cTnI elevation after AIS are associated with stroke severity, unfavourable functional outcome, and short-term mortality.
Cardiocenter Charles University 3rd Faculty of Medicine Ruská 87 100 00 Prague Czech Republic
Medtronic Czechia Partner of INTERCARDIS Prosecká 852 66 190 00 Prague Czech Republic
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Sposato LA, Hilz MJ, Aspberg S, Murthy SB, Bahit MC, Hsieh CYet al. . Post-stroke cardiovascular complications and neurogenic cardiac injury: JACC state-of-the-art review. J Am Coll Cardiol 2020;76:2768–2785. PubMed
Mihalovic M, Tousek P. Myocardial injury after stroke. J Clin Med 2022;11:2. 10.3390/jcm11010002 PubMed DOI PMC
Biso S, Wongrakpanich S, Agrawal A, Yadlapati S, Kishlyansky M, Figueredo V. A review of neurogenic stunned myocardium. Cardiovasc Psychiatry Neurol 2017;2017:5842182. PubMed PMC
Lanas F, Seron P. Facing the stroke burden worldwide. Lancet Glob Health 2021;9:e235–e236. PubMed
Scheitz JF, Sposato LA, Schulz-Menger J, Nolte CH, Backs J, Endres M. Stroke-heart syndrome: recent advances and challenges. J Am Heart Assoc 2022;11:e026528. PubMed PMC
Reichlin T, Schindler C, Drexler B, Twerenbold R, Reiter M, Zellweger Cet al. . One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 2012;172:1211–1218. PubMed
Jaeger C, Wildi K, Twerenbold R, Reichlin T, Rubini Gimenez M, Neuhaus JDet al. . One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. Am Heart J 2016;171:92–102.e1–5. PubMed
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker Ket al. . 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49:e46–e110. PubMed
Thygesen K. ‘Ten commandments’ for the fourth universal definition of myocardial infarction 2018. Eur Heart J 2019;40:226. PubMed
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DAet al. . Fourth universal definition of myocardial infarction (2018). Circulation 2018;138:e618–e651. PubMed
Domienik-Karlowicz J, Kupczynska K, Michalski B, Kaplon-Cieslicka A, Darocha S, Dobrowolski Pet al. . Fourth universal definition of myocardial infarction. Selected messages from the European Society of Cardiology document and lessons learned from the new guidelines on ST-segment elevation myocardial infarction and non-ST-segment elevation-acute coronary syndrome. Cardiol J 2021;28:195–201. PubMed PMC
Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. Non-coronary disease. Eur Heart J 2011;32:404–411. PubMed
Sun Y, Miller MM, Yaghi S, Silver B, Henninger N. Association of baseline cardiac troponin with acute myocardial infarction in stroke patients presenting within 4.5 hours. Stroke 2020;51:108–114. PubMed PMC
Su YC, Huang KF, Yang FY, Lin SK. Elevation of troponin I in acute ischemic stroke. PeerJ 2016;4:e1866. PubMed PMC
Sui Y, Liu T, Luo J, Xu B, Zheng L, Zhao Wet al. . Elevation of high-sensitivity cardiac troponin T at admission is associated with increased 3-month mortality in acute ischemic stroke patients treated with thrombolysis. Clin Cardiol 2019;42:881–888. PubMed PMC
He L, Wang J, Dong W. The clinical prognostic significance of hs-cTnT elevation in patients with acute ischemic stroke. BMC Neurol 2018;18:118. PubMed PMC
Faiz KW, Thommessen B, Einvik G, Omland T, Ronning OM. Prognostic value of high-sensitivity cardiac troponin T in acute ischemic stroke. J Stroke Cerebrovasc Dis 2014;23:241–248. PubMed
Ali F, Young J, Rabinstein AA, Flemming KD, Fugate JE. Routine troponin measurements are unnecessary to exclude asymptomatic coronary events in acute ischemic stroke patients. J Stroke Cerebrovasc Dis 2016;25:1215–1221. PubMed
VanHouten J, Fricker G, Collins B, Bhatia R, Ellis C, Schrag M. Circulating troponin I level in patients with acute ischemic stroke. Curr Neurol Neurosci Rep 2018;18:32. PubMed
Fan Y, Jiang M, Gong D, Man C, Chen Y. Cardiac troponin for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis. Biosci Rep 2018;38:BSR20171178. PubMed PMC
Mihalovic M, Mikulenka P, Línková H, Neuberg M, Štětkářová I, Peisker Tet al. . Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in patients after acute stroke: relation to stroke severity, myocardial injury, and impact on prognosis. J Clin Med 2022;11:2552. PubMed PMC
Kenigsberg BB, Barnett CF, Mai JC, Chang JJ. Neurogenic stunned myocardium in severe neurological injury. Curr Neurol Neurosci Rep 2019;19:90. PubMed
Chen Z, Venkat P, Seyfried D, Chopp M, Yan T, Chen J. Brain-heart interaction: cardiac complications after stroke. Circ Res 2017;121:451–468. PubMed PMC
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