Chang Andrew, Ricci Brittany, Grory Brian Mac, Cutting Shawna, Burton Tina, Dakay Katarina, Jayaraman Mahesh, Merkler Alexander, Reznik Michael, Lerario Michael P, Song Christopher, Kamel Hooman, Elkind Mitchell S V, Furie Karen, Yaghi Shadi
Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1726-1731. doi: 10.1016/j.jstrokecerebrovasdis.2019.02.013. Epub 2019 Mar 19.
Cardiac biomarkers may help identify stroke mechanisms and may aid in improving stroke prevention strategies. There is limited data on the association between these biomarkers and acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). We hypothesized that cardiac biomarkers (cardiac troponin and left atrial diameter [LAD]) would be associated with the presence of LVO.
Data were abstracted from a single center prospective AIS database over 18 months and included all patients with AIS with CT angiography of the head and neck. The presence of LVO was defined as proximal LVO of the internal carotid artery terminus, middle cerebral artery (M1 or proximal M2), or basilar artery. Univariate analyses and predefined multivariable models were performed to determine the association between cardiac biomarkers (positive troponin [troponin ≥0.1 ng/mL] and LAD on transthoracic echocardiogram) and LVO adjusting for demographic factors (age and sex), risk factors (hypertension, diabetes, hyperlipidemia, history of stroke, congestive heart failure, coronary heart disease, and smoking), and atrial fibrillation (AF).
We identified 1234 patients admitted with AIS; 886 patients (71.8%) had vascular imaging to detect LVO. Of those with imaging available, 374 patients (42.2%) had LVO and 207 patients (23.4%) underwent thrombectomy. There was an association between positive troponin and LVO after adjusting for age, sex and other risk factors (adjusted OR 1.69 [1.08-2.63], P = .022) and this association persisted after including AF in the model (adjusted OR 1.60 [1.02-2.53], P = 0.043). There was an association between LAD and LVO after adjusting for age, sex, and risk factors (adjusted OR per mm 1.03 [1.01-1.05], P = 0.013) but this association was not present when AF was added to the model (adjusted OR 1.01 [0.99-1.04], P = .346). Sensitivity analyses using thrombectomy as an outcome yielded similar findings.
Cardiac biomarkers, particularly serum troponin levels, are associated with acute LVO in patients with ischemic stroke. Prospective studies are ongoing to confirm this association and to test whether anticoagulation reduces the risk of recurrent embolism in this patient population.
心脏生物标志物可能有助于识别卒中机制，并有助于改进卒中预防策略。关于这些生物标志物与大血管闭塞（LVO）所致急性缺血性卒中（AIS）之间关联的数据有限。我们推测心脏生物标志物（心肌肌钙蛋白和左心房直径[LAD]）将与LVO的存在相关。
数据来自一个单中心前瞻性AIS数据库，为期18个月，纳入了所有接受头颈部CT血管造影的AIS患者。LVO的存在定义为颈内动脉末端、大脑中动脉（M1或M2近端）或基底动脉的近端LVO。进行单因素分析和预定义的多变量模型，以确定心脏生物标志物（肌钙蛋白阳性[肌钙蛋白≥0.1 ng/mL]和经胸超声心动图测量的LAD）与LVO之间的关联，并对人口统计学因素（年龄和性别）、危险因素（高血压、糖尿病、高脂血症、卒中史、充血性心力衰竭、冠心病和吸烟）以及心房颤动（AF）进行校正。
我们确定了1234例因AIS入院的患者；886例患者（71.8%）进行了血管成像以检测LVO。在有成像资料的患者中，374例（42.2%）存在LVO，207例（23.4%）接受了血栓切除术。在校正年龄、性别和其他危险因素后，肌钙蛋白阳性与LVO之间存在关联（校正OR 1.69[1.08 - 2.63]，P = 0.022），在模型中纳入AF后，这种关联仍然存在（校正OR 1.60[1.02 - 2.53]，P = 0.043）。在校正年龄、性别和危险因素后，LAD与LVO之间存在关联（每毫米校正OR 1.03[1.01 - 1.05]，P = 0.013），但在模型中加入AF后，这种关联不存在（校正OR 1.01[0.99 - 1.04]，P = 0.346）。以血栓切除术作为结局的敏感性分析得出了类似的结果。
心脏生物标志物，尤其是血清肌钙蛋白水平，与缺血性卒中患者的急性LVO相关。正在进行前瞻性研究以证实这种关联，并测试抗凝治疗是否能降低该患者群体复发性栓塞的风险。
