Bustamante Alejandro, Díaz-Fernández Belén, Pagola Jorge, Blanco-Grau Albert, Rubiera Marta, Penalba Anna, García-Berrocoso Teresa, Montaner Joan
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Eur Stroke J. 2016 Sep;1(3):205-212. doi: 10.1177/2396987316654337. Epub 2016 Jun 21.
The importance of troponin elevation at stroke presentation remains uncertain. We aimed to assess whether baseline ultrasensitive Troponin I (hs-TnI) predicts cardiac complications and outcome in acute stroke patients.
Stroke patients admitted within 6 h were consecutively enrolled from May 2013 to March 2014. Blood samples were taken at admission to determine hs-TnI by chemiluminescent microparticle immunoassay. hs-TnI > 34.2 pg/ml (male) and >15.6 pg/ml (female) were considered elevated. Complications during in-hospital stay and outcome at 90 days were prospectively recorded. Independent predictors of cardiac complications (heart failure and acute coronary syndrome) and mortality were determined by logistic regression. The additional predictive value of hs-TnI was evaluated by integrated discrimination improvement index. A subanalysis was performed after excluding patients with previous cardiac diseases.
From 174 patients, 39(22%) had elevated hs-TnI, having these patients higher incidence of cardiac complications (57% versus 19%, p = 0.004). hs-TnI was an independent predictor of cardiac complications (OR = 16.1 (1.7-150.3)) together with diastolic blood pressure (OR = 0.92 (0.86-0.99)). Addition of hs-TnI to clinical variables significantly improved discrimination (IDI = 15.2% (7.8-22.7)). Subanalysis in patients without previous cardiac diseases showed similar results. Elevated hs-TnI was independently associated with 90 days mortality (OR = 3.6 (1.3-9.4)), but addition of hs-TnI to clinical data did not result in an increased discrimination.
The present study confers hs-TnI a 2b level of evidence as a diagnostic tool to predict cardiac complications in stroke. Absence of serial hs-TnI measurements and limited sample size are the main weaknesses of the study.
Patients with elevated baseline hs-TnI showed a higher frequency of cardiac complications and a higher mortality. Measurement of hs-TnI in acute stroke might be useful to identify patients at a high risk of cardiac complications and death.
卒中发病时肌钙蛋白升高的重要性仍不确定。我们旨在评估基线超敏肌钙蛋白I（hs-TnI）是否能预测急性卒中患者的心脏并发症及预后。
连续纳入2013年5月至2014年3月期间发病6小时内入院的卒中患者。入院时采集血样，采用化学发光微粒子免疫分析法测定hs-TnI。男性hs-TnI>34.2 pg/ml、女性>15.6 pg/ml被视为升高。前瞻性记录住院期间的并发症及90天时的预后情况。通过逻辑回归确定心脏并发症（心力衰竭和急性冠状动脉综合征）及死亡率的独立预测因素。通过综合判别改善指数评估hs-TnI的额外预测价值。排除既往有心脏病的患者后进行亚组分析。
174例患者中，39例（22%）hs-TnI升高，这些患者心脏并发症的发生率更高（57%对19%，p = 0.004）。hs-TnI与舒张压一起是心脏并发症的独立预测因素（比值比[OR]=16.1[1.7 - 150.3]）（OR = 0.92[0.86 - 0.99]）。将hs-TnI加入临床变量可显著改善判别能力（综合判别改善指数[IDI]=15.2%[7.8 - 22.7]）。在无既往心脏病的患者中进行的亚组分析显示了类似结果。hs-TnI升高与90天死亡率独立相关（OR = 3.6[1.3 - 9.4]），但将hs-TnI加入临床数据并未提高判别能力。
本研究赋予hs-TnI作为预测卒中患者心脏并发症的诊断工具2b级证据水平。缺乏连续的hs-TnI测量及样本量有限是本研究的主要不足。
基线hs-TnI升高的患者心脏并发症发生率更高，死亡率也更高。急性卒中时测定hs-TnI可能有助于识别有心脏并发症和死亡高风险的患者。
