Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-Communicable Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, Jiangsu Province, China.
Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China.
J Neurol. 2024 Sep;271(9):6313-6324. doi: 10.1007/s00415-024-12536-5. Epub 2024 Aug 6.
Impaired cardiac function was suggested to be implicated in the functional recovery after ischemic stroke, but the prognostic value of cardiac biomarkers among ischemic stroke patients remains unclear. We aimed to prospectively explore the associations of serum lactate dehydrogenase (LDH), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), and plasma high-sensitivity cardiac troponin T (hs-cTnT) with adverse clinical outcomes after ischemic stroke in a large-scale cohort study.
We measured serum LDH, plasma NT-proBNP, and plasma hs-cTnT levels at baseline among 5056 ischemic stroke patients from the Minhang Stroke Cohort study. All patients were followed up at 3 months after ischemic stroke onset. The primary outcome was composite outcome of death and major disability (modified Rankin Scale [mRS] score ≥ 3) at 3 months after stroke onset, and secondary outcomes included death and ordered 7-level categorical score of the mRS.
During 3 months of follow-up, 1584 patients developed the primary outcome. Baseline serum LDH, plasma NT-proBNP, and plasma hs-cTnT were positively associated with the risk of adverse outcomes after ischemic stroke. The multivariable-adjusted odds ratios of primary outcome for the highest versus lowest quartile of LDH, NT-proBNP, and hs-cTnT were 1.37 (95% CI 1.13-1.66; P = 0.001), 2.51 (95% CI, 2.00-3.16; P < 0.001), and 2.24 (95% CI 1.77-2.83; P < 0.001), respectively. Each SD increase of log-transformed cardiac biomarker score was associated with a 49% (95% CI 37-62%; P < 0.001) increased risk of primary outcome. Multivariable-adjusted spline regression analyses showed linear relationships between cardiac biomarkers and the risk of primary outcome (all P for linearity < 0.001). Moreover, adding LDH, NT-proBNP, hs-cTnT, or cardiac biomarker score to conventional risk factors significantly improved the risk reclassification of primary outcome after ischemic stroke (all P < 0.05).
High LDH, NT-proBNP, hs-cTnT, and cardiac biomarker score were independently associated with increased risks of adverse clinical outcomes among ischemic stroke patients, suggesting that cardiac biomarkers might be potential prognostic biomarkers for ischemic stroke.
心脏功能受损被认为与缺血性脑卒中后的功能恢复有关，但心脏生物标志物在缺血性脑卒中患者中的预后价值仍不清楚。我们旨在通过一项大规模队列研究，前瞻性地探讨血清乳酸脱氢酶（LDH）、血浆 N 末端脑利钠肽前体（NT-proBNP）和血浆高敏心肌肌钙蛋白 T（hs-cTnT）与缺血性脑卒中后不良临床结局的关系。
我们在闵行脑卒中队列研究中测量了 5056 例缺血性脑卒中患者的基线血清 LDH、血浆 NT-proBNP 和血浆 hs-cTnT 水平。所有患者均在缺血性脑卒中发病后 3 个月进行随访。主要结局为脑卒中发病后 3 个月时死亡和主要残疾（改良 Rankin 量表[ mRS ]评分≥3）的复合结局，次要结局包括死亡和 mRS 的 7 级分类评分。
在 3 个月的随访期间，1584 例患者发生了主要结局。基线血清 LDH、血浆 NT-proBNP 和血浆 hs-cTnT 与缺血性脑卒中后不良结局的风险呈正相关。LDH、NT-proBNP 和 hs-cTnT 最高四分位与最低四分位相比，主要结局的多变量校正比值比分别为 1.37（95%CI 1.13-1.66；P=0.001）、2.51（95%CI 2.00-3.16；P<0.001）和 2.24（95%CI 1.77-2.83；P<0.001）。每个 log 转化的心脏生物标志物评分的标准差增加与主要结局的风险增加 49%（95%CI 37-62%；P<0.001）相关。多变量校正样条回归分析显示，心脏标志物与主要结局的风险之间呈线性关系（所有 P 值均<0.001）。此外，将 LDH、NT-proBNP、hs-cTnT 或心脏生物标志物评分添加到常规危险因素中，可显著提高缺血性脑卒中后主要结局的风险再分类（所有 P 值均<0.05）。
高 LDH、NT-proBNP、hs-cTnT 和心脏生物标志物评分与缺血性脑卒中患者不良临床结局的风险增加独立相关，提示心脏标志物可能是缺血性脑卒中的潜在预后标志物。
