Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
PLoS One. 2018 Dec 31;13(12):e0209764. doi: 10.1371/journal.pone.0209764. eCollection 2018.
Differential diagnosis of elevated high sensitive Troponin T (hsTnT) in acute ischemic stroke includes myocardial infarction (MI) and neurogenic stunned myocardium (NSM). The aim of this study was to identify factors associated with baseline hsTnT levels and MI or NSM in acute ischemic stroke.
We studied 204 consecutive patients of the prospective acquired Bern Stroke Database with acute ischemic stroke diagnosed by brain MR. All patient histories and cardiac examinations were reviewed retrospectively. Volumetry of lesions on diffusion and perfusion weighted brain imaging (circular singular value decomposition, Tmax >6sec) was performed. Voxel based analysis was performed to identify brain areas associated with hsTnT elevation. Linear regression analysis was used to identify predictors of baseline hsTnT levels and myocardial infarction.
Elevated hsTnT was observed in 58 of the 204 patients (28.4%). The mean age was 68.3 years in the normal hsTnT group and 69.7 years in the elevated hsTnT group. Creatinine (p<0.001, OR 6.735, 95% CI 58.734-107.423), baseline NIHSS score (p = 0.029, OR 2.207, 95% CI 0.675-12.096), ST segment depression (p = 0.025, OR 2.259, 95% CI 2.419-35.838), and negative T waves in baseline ECG (p = 0.002, OR 3.209, 95% CI 13.007-54.564) were associated with hsTnT elevation, while infarct location and size were not. Coronary angiography was performed in 30 of the 204 patients (14.7%) and myocardial infarction was diagnosed in 7 of them (23.3%). Predictive factors for myocardial infarction could not be identified.
Elevated baseline baseline hsTnT was associated with NIHSS, creatinine, ST segment depression and inverted T waves, but not with stroke location or size. None of the factors was helpful to differentiate MI and NSM. Therefore, ancillary investigations such as coronary angiography, cardiac MRI or both may be needed to solve the differential diagnosis.
在急性缺血性脑卒中患者中，升高的高敏肌钙蛋白 T（hsTnT）的鉴别诊断包括心肌梗死（MI）和神经源性心肌顿抑（NSM）。本研究旨在确定与急性缺血性脑卒中患者基线 hsTnT 水平升高以及 MI 或 NSM 相关的因素。
我们对前瞻性获得的伯尔尼卒中数据库中的 204 例连续急性缺血性脑卒中患者进行了研究，这些患者通过脑磁共振成像（MRI）确诊。回顾性地对所有患者的病史和心脏检查进行了审查。对扩散和灌注加权脑成像上的病变容积（圆形奇异值分解，Tmax>6 秒）进行了测量。使用体素基分析来确定与 hsTnT 升高相关的脑区。使用线性回归分析来确定基线 hsTnT 水平和心肌梗死的预测因素。
在 204 例患者中，有 58 例（28.4%）hsTnT 升高。在正常 hsTnT 组，患者的平均年龄为 68.3 岁，在 hsTnT 升高组，患者的平均年龄为 69.7 岁。肌酐（p<0.001，OR 6.735，95%CI 58.734-107.423）、基线 NIHSS 评分（p=0.029，OR 2.207，95%CI 0.675-12.096）、ST 段压低（p=0.025，OR 2.259，95%CI 2.419-35.838）和基线心电图的倒置 T 波（p=0.002，OR 3.209，95%CI 13.007-54.564）与 hsTnT 升高相关，而梗死部位和大小则无相关性。在 204 例患者中，有 30 例行冠状动脉造影术（14.7%），其中 7 例（23.3%）诊断为心肌梗死。但无法确定心肌梗死的预测因素。
基线 hsTnT 升高与 NIHSS、肌酐、ST 段压低和倒置 T 波相关，但与卒中部位或大小无关。这些因素均无助于区分 MI 和 NSM。因此，可能需要辅助检查，如冠状动脉造影、心脏 MRI 或两者都有，以解决鉴别诊断问题。
