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.
Stroke. 2018 Jan;49(1):121-126. doi: 10.1161/STROKEAHA.117.019395. Epub 2017 Nov 22.
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).
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.
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; =0.003) and cardioembolic stroke subtype (odds ratio, 5.00; 95% confidence interval, 1.83-13.63; =0.002).
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.
心肌肌钙蛋白升高是心脏病的标志物，最近有研究表明其与栓塞性卒中风险相关。我们假设，在急性卒中情况下，早期升高的肌钙蛋白水平在栓塞性卒中亚型（心源性和不明来源的栓塞性卒中）患者中比非心源性亚型（大血管疾病、小血管疾病和其他）更为常见。
我们从前瞻性缺血性卒中数据库中提取数据，纳入了 18 个月期间所有缺血性卒中患者。根据我们实验室的标准，将肌钙蛋白阳性定义为≥0.1ng/mL，肌钙蛋白中间值定义为≥0.06ng/mL 且<0.1ng/mL。建立未调整和调整后的回归模型，以确定卒中亚型（不明来源的栓塞性卒中和心源性卒中亚型）与肌钙蛋白阳性和中间值之间的关联，调整了关键混杂因素，包括人口统计学因素（年龄和性别）、临床特征（高血压、高血脂、糖尿病、肾功能、冠心病、充血性心力衰竭、当前吸烟和 NIHSS 评分）、心脏变量（左心房直径、壁运动异常、射血分数和心电图 PR 间期）和梗死的岛叶累及情况。
我们确定了 1234 例患者，其中 1129 例有入院时的肌钙蛋白水平，10.0%（113/1129）的患者肌钙蛋白阳性。在完全调整的模型中，肌钙蛋白阳性与不明来源的栓塞性卒中亚型（调整后的优势比，4.46；95%置信区间，1.03-7.97；=0.003）和心源性卒中亚型（优势比，5.00；95%置信区间，1.83-13.63；=0.002）相关。
我们发现，缺血性卒中后早期的肌钙蛋白阳性可能与心脏栓塞源独立相关。需要进一步的研究来使用高敏肌钙蛋白检测来证实我们的发现，并测试不明来源的栓塞性卒中和肌钙蛋白阳性患者的最佳二级预防策略。
