Lesch Hendrik, Haucke Lea, Kruska Mathieu, Ebert Anne, Becker Louisa, Szabo Kristina, Akin Ibrahim, Alonso Angelika, Fastner Christian
Department of Neurology, Faculty of Medicine Mannheim, Mannheim Center for Translational Neuroscience (MCTN), University of Heidelberg, Mannheim, Germany.
Department of Cardiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
Front Neurol. 2025 Feb 18;16:1510361. doi: 10.3389/fneur.2025.1510361. eCollection 2025.
Elevated cardiac troponin (cTn) levels (representing myocardial injury) are frequently found in patients with spontaneous intracerebral hemorrhage (sICH). Overall, the relationship between sICH and elevated cTn levels is not well understood. The aim of this study was to investigate patient characteristics and clinical parameters in patients with sICH and myocardial injury.
This is a retrospective observational study based on the Mannheim Stroke database. Consecutive patient cases with acute symptomatic sICH and available high-sensitivity cTn I (hs-cTnI) at hospital admission between 2015 and 2021 were included. Group comparisons of patient, clinical and imaging characteristics were performed between groups with and without hs-cTnI elevation. In addition, variables with suspected predictive clinical significance for hs-cTnI elevation were analyzed for their predictive value using multivariate logistic regression analysis.
A total of 93/498 patients with sICH (18.7%; mean age 73 ± 15 years; 51.9% females) had a hs-cTnI elevation. These patients did not have a more pronounced cerebrovascular risk profile and had a comparably low prevalence of coronary artery disease (18.5%, = NS) compared to those without elevated hs-cTnI levels. Elevated hs-cTnI levels had no impact on in-hospital mortality (21.5 vs. 20.5%, = NS) or functional outcome at discharge. Solely clinically relevant aortic valve stenosis, graded as moderate or higher, independently predicted hs-cTnI elevation ( < 0.003). Other cardiac preconditions or neurological functional parameters did not serve as significant predictors.
Myocardial injury is common in patients with sICH. Unlike in AIS patients, elevated hs-cTnI levels were not associated with a worse functional or mortality-related in-hospital outcome. Except for clinically relevant aortic valve stenosis, structural heart disease had no significant influence as a predictor. We therefore suggest that hs-cTnI elevation in patients with sICH is related to acute myocardial damage along the brain-heart axis.
在自发性脑出血（sICH）患者中经常发现心脏肌钙蛋白（cTn）水平升高（代表心肌损伤）。总体而言，sICH与cTn水平升高之间的关系尚未完全明确。本研究的目的是调查sICH和心肌损伤患者的特征及临床参数。
这是一项基于曼海姆卒中数据库的回顾性观察研究。纳入2015年至2021年间入院时患有急性症状性sICH且有可用的高敏肌钙蛋白I（hs-cTnI）的连续患者病例。对hs-cTnI升高和未升高的组进行患者、临床和影像学特征的组间比较。此外，使用多因素逻辑回归分析对疑似对hs-cTnI升高具有预测临床意义的变量进行预测价值分析。
共有93/498例sICH患者（18.7%；平均年龄73±15岁；51.9%为女性）hs-cTnI升高。与hs-cTnI水平未升高的患者相比，这些患者没有更明显的脑血管风险特征，冠状动脉疾病的患病率相对较低（18.5%，P=无显著性差异）。hs-cTnI水平升高对住院死亡率（21.5%对20.5%，P=无显著性差异）或出院时的功能结局没有影响。仅临床上相关的中度或更高等级的主动脉瓣狭窄独立预测hs-cTnI升高（P<0.003）。其他心脏疾病或神经功能参数不是显著的预测因素。
心肌损伤在sICH患者中很常见。与急性缺血性卒中（AIS）患者不同，hs-cTnI水平升高与住院期间较差的功能或死亡率相关结局无关。除了临床上相关的主动脉瓣狭窄外，结构性心脏病作为预测因素没有显著影响。因此，我们认为sICH患者hs-cTnI升高与脑-心轴上的急性心肌损伤有关。
