Abstract TP128: The Clinical Implications Of Cerebrogenic Myocardial Injury In Acute Stroke
Background and purpose: Serum cardiac troponin-I (cTnI) can be increased in acute stroke. It has been hypothesized that elevated cTnI levels in stroke are due to cerebrogenic myocardial injury (CMI) caused by sympathoadrenal activation. However, there is still little information for clinical implications of CMI. The aim of this study was to identify the relationships between CMI and clinical characteristics of stroke patients.
Methods: We performed a retrospective analysis of 2114 consecutive stroke patients. We excluded the patients with other conditions for cTnI elevation including acute coronary syndrome, congestive heart failure, chronic kidney disease and myocarditis. Finally, we divided those selected patients into 2 groups: 1) CMI group: cTnI≥0.06 ng/l; 2) non-CMI group: cTnI<0.06 ng/l. We compared demographics, stroke severity by the mNIHSS, stroke types and stroke locations. Univariate analysis was used to screen for predictive factors (P≤0.10) and these variables were entered into the final multivariable logistic regression model along with gender and age.
Results: Of 2114 consecutive patients, 254 patients (12.01%) were defined as CMI group. CMI was associated with older age (67.49±12.54 vs 65.35±12.61; p=0.011), ischemic heart disease (11.8% vs 7.4%; p=0.015), higher mNIHSS (8.40±7.29 vs 6.12±6.00; p<0.001) and rapid heart rate (81.48±19.15 vs 77.71±18.02, p=0.005). Gender, hypertension, diabetes, atrial fibrillation, hyperlipidemia, stroke location, stroke type, and blood pressure had no significant association with CMI. In logistic regression analyses, CMI was significantly associated with ischemic heart disease (OR 1.81; 95% CI 1.17-2.80), mNIHSS (OR 1.05; 95% CI 1.03-1.07), heart rate (OR 1.01; 95% CI 1.00-1.02) after controlling for gender and age.
Conclusions: This study showed that the patients with severe neurological deficits, ischemic heart disease, and rapid heart rate were predisposed to CMI. These findings support that abnormal sympathetic activations are important in CMI and these reactions are related with severity of stroke and vulnerability of heart against ischemic insult. Further prospective studies are needed to evaluate the clinical significance of CMI in acute stroke patients.
- © 2012 by American Heart Association, Inc.