Hess Felix, McGinnis Julian, Baki Enayatullah, Wiltgen Tun, Müller Arne, Maegerlein Christian, Kirschke Jan, Zimmer Claus, Hemmer Bernhard, Wunderlich Silke, Mühlau Mark
Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Computer Science, School of Computation, Information and Technology, Technical University of Munich, Munich, Germany.
Clin Neuroradiol. 2025 Jan 30. doi: 10.1007/s00062-025-01498-4.
Myocardial injury, indicated by an elevation of high-sensitive cardiac Troponin (hs-cTnT), is a frequent stroke-related complication. Most studies investigated patients with ischemic stroke, but only little is known about its occurrence in patients with intracerebral hemorrhage (ICH). This study aimed to assess the frequency, predictors, and implications of myocardial injury in ICH patients.
Our retrospective analysis included 322 ICH patients. We defined myocardial injury as an elevation of hs-cTnT above the 99th percentile (i.e. 14 ng/L). Acute myocardial injury was defined as either a changing pattern of > 50% within 24 h or an excessive elevation of initial hs-cTnT (> 52 ng/L). 3D brain scans were assessed for ICH visually and quantitatively by a deep learning algorithm. Multiple regression models and Voxel-based Lesion-Symptom Mapping (VLSM) were applied.
63.0% (203/322) of patients presented with myocardial injury, which was associated with more severe strokes and worse outcomes during the in-hospital phase (P < 0.01). Acute myocardial injury occurred in 24.5% (79/322) of patients. The only imaging finding associated with acute myocardial injury was midline shift (69.8% vs. 44.6% for normal or stable hs-cTnT, P < 0.01), which also independently predicted it (odds ratio 3.29, confidence interval 1.38-7.87, P < 0.01). In contrast, VLSM did not identify any specific brain region significantly associated with acute myocardial injury. Acute myocardial injury did not correlate with preexisting cardiac diseases; however, the frequency of adverse cardiac events was higher in the acute myocardial injury group (11.4% vs. 4.1% in patients with normal and/or stable patterns of hs-cTnT, P < 0.05).
Myocardial injury occurs frequently in ICH and is linked to poor outcomes. Acute myocardial injury primarily correlates to space-occupying effects of ICH but is less dependent on premorbid cardiac status. Nonetheless, it is associated with a higher rate of adverse cardiac events.
高敏心肌肌钙蛋白（hs-cTnT）升高所提示的心肌损伤是一种常见的卒中相关并发症。大多数研究调查的是缺血性卒中患者，而对于脑出血（ICH）患者中该并发症的发生情况了解甚少。本研究旨在评估ICH患者中心肌损伤的发生率、预测因素及影响。
我们的回顾性分析纳入了322例ICH患者。我们将心肌损伤定义为hs-cTnT升高超过第99百分位数（即14 ng/L）。急性心肌损伤定义为24小时内变化模式>50%或初始hs-cTnT过度升高（>52 ng/L）。通过深度学习算法对ICH患者的3D脑部扫描进行视觉和定量评估。应用多元回归模型和基于体素的病变-症状映射（VLSM）。
63.0%（203/322）的患者出现心肌损伤，这与更严重的卒中及住院期间更差的预后相关（P<0.01）。24.5%（79/322）的患者发生急性心肌损伤。与急性心肌损伤相关的唯一影像学发现是中线移位（hs-cTnT正常或稳定者为44.6%，急性心肌损伤患者为69.8%，P<0.01），这也独立预测了急性心肌损伤（比值比3.29，置信区间1.38 - 7.87，P<0.01）。相比之下，VLSM未发现任何与急性心肌损伤显著相关的特定脑区。急性心肌损伤与既往存在的心脏疾病无关；然而，急性心肌损伤组不良心脏事件的发生率更高（hs-cTnT正常和/或稳定模式的患者为4.1%，急性心肌损伤组为11.4%，P<0.05）。
心肌损伤在ICH患者中频繁发生且与不良预后相关。急性心肌损伤主要与ICH的占位效应相关，但较少依赖于病前心脏状况。尽管如此，它与更高的不良心脏事件发生率相关。
