高敏心肌肌钙蛋白T与大脑中动脉供血区脑梗死及动态脑自动调节的关系
Association of high-sensitivity cardiac troponin T with territorial middle cerebral artery brain infarctions and dynamic cerebral autoregulation.
作者信息
Bolognese Manuel, Weichsel Laura, Österreich Mareike, Müller Martin, Karwacki Grzegorz Marek, Lakatos Lehel-Barna
机构信息
Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Department of Radiology and Nuclear Medicine, Section for Diagnostic and Interventional Neuroradiology, Lucerne Cantonal Hospital, Lucerne, Switzerland.
出版信息
J Cent Nerv Syst Dis. 2024 Nov 25;16:11795735241302725. doi: 10.1177/11795735241302725. eCollection 2024.
BACKGROUND
Cardiac high-sensitivity troponin T (hs-cTnT) is linked to the cardioembolic origin, severity, and outcome of acute ischemic stroke. Furthermore, larger brain infarctions are often accompanied by impaired dynamic cerebral autoregulation (dCA), which is also indicative of a poor prognosis.
OBJECTIVES
This study aimed to investigate whether hs-cTnT levels can serve as a predictor of dCA impairment.
DESIGN
Retrospective cohort study.
METHODS
In 330 consecutive patients with stroke (age 71 years [IQR 59-78]; 100 women; 229 territorial and 111 non-territorial brain infarcts) with successful dCA assessment, hs-cTnT levels were measured within 24 hours of stroke onset. These measurements were analyzed in relation to cerebrovascular risk factors, stroke origin, stroke severity (National Institute of Health Stroke Scale, NIHSS at entry), modified Rankin scale (mRs) at 3 months, and stroke volume determined by cranial computed tomography perfusion (CTP). dCA was assessed using transfer function analysis, which assessed the relationship between middle cerebral artery blood flow velocity and blood pressure. Coherence, gain, and phase were estimated across 3 frequency ranges: very low (0.02-0.07 Hz), low (0.07-0.15 Hz), and high (0.15-0.5 Hz).
RESULTS
In univariate analysis, hs-cTnT was associated with cardioembolism and territorial infarction. In the multinomial logistic regression analysis, independent risk factors for the presence of a territorial infarction included atrial fibrillation, the NIHSS score, the infarct core on CTP, cardioembolism, and large vessel disease, but not hs-cTnT levels. Risk factors for a poor outcome (mRs >2) included age, hs-cTnT, and NIHSS score. Overall, the coherence, gain, and phase were not predicted by hs-cTnT levels.
CONCLUSIONS
Hs-cTnT levels are associated with poor stroke outcomes. However, they do not predict dCA impairment.
REGISTRATION
ClinicalTrials.gov NCT04611672, 11.10.2020.
背景
心脏高敏肌钙蛋白T（hs-cTnT）与急性缺血性卒中的心源性栓塞起源、严重程度及预后相关。此外，较大的脑梗死常伴有动态脑自动调节（dCA）受损，这也提示预后不良。
目的
本研究旨在探讨hs-cTnT水平是否可作为dCA受损的预测指标。
设计
回顾性队列研究。
方法
在330例连续的卒中患者（年龄71岁[四分位间距59 - 78岁]；100例女性；229例为局部性脑梗死，111例为非局部性脑梗死）中成功评估了dCA，在卒中发作后24小时内测量hs-cTnT水平。对这些测量结果与脑血管危险因素、卒中起源、卒中严重程度（入院时美国国立卫生研究院卒中量表，NIHSS）、3个月时的改良Rankin量表（mRs）以及通过头颅计算机断层扫描灌注（CTP）测定的卒中体积进行分析。使用传递函数分析评估dCA，该分析评估大脑中动脉血流速度与血压之间的关系。在3个频率范围内估计相干性、增益和相位：极低（0.02 - 0.07Hz）、低（0.07 - 0.15Hz）和高（0.15 - 0.5Hz）。
结果
在单因素分析中，hs-cTnT与心源性栓塞和局部性梗死相关。在多项逻辑回归分析中，局部性梗死存在的独立危险因素包括心房颤动、NIHSS评分、CTP上的梗死核心、心源性栓塞和大血管疾病，但不包括hs-cTnT水平。预后不良（mRs>2）的危险因素包括年龄、hs-cTnT和NIHSS评分。总体而言，hs-cTnT水平不能预测相干性、增益和相位。
结论
Hs-cTnT水平与卒中不良预后相关。然而，它们不能预测dCA受损。
注册信息
ClinicalTrials.gov NCT04611672，2020年10月11日。
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