Lesch Hendrik, Kruska Mathieu, Marx Alexander, Haucke Lea, Ebert Anne, Becker Louisa, Szabo Kristina, Akin Ibrahim, Alonso Angelika, Fastner Christian
Department of Neurology, University Medical Centre Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Cardiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, European Centre for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
J Neurol Sci. 2025 Sep 15;476:123633. doi: 10.1016/j.jns.2025.123633. Epub 2025 Jul 23.
Growing evidence suggests worse outcomes in patients with spontaneous intracerebral hemorrhage (sICH) and elevated cardiac troponin (cTn) level. While the predictive value of isolated cTn elevation in sICH on outcomes is unclear, few studies have examined patients with follow-up measurement of cTn level. The aim of this study was to investigate the association of a dynamic change in high-sensitivity cTn I (hs-cTnI) levels with in-hospital outcomes in sICH patients.
This retrospective study included acute sICH patients between 2015 and 2021 with serial hs-cTnI level measurement. Group comparisons were performed between patients with dynamic hs-cTnI change, i.e., rise or fall of hs-cTnI levels on follow-up measurement >20 %, and those with stable hs-cTnI levels. Variables with suspected impact on in-hospital mortality were analyzed for their predictive value using multivariate logistic regression analysis.
A total of 55/105 sICH patients were found to have a dynamic change in hs-cTnI levels. A dynamic change in hs-cTnI levels was significantly associated with in-hospital mortality. Frequency of intraventricular hemorrhage (IVH) was higher in the dynamic group, while vascular risk profile, burden of coronary artery disease and functional neurological status at admission were evenly distributed. While a dynamic change in hs-cTnI levels showed a trend, solely IVH independently predicted in-hospital mortality.
We suggest that a hs-cTnI dynamic is an expression of the acute myocardial 'hit' driven by sICH along the brain-heart axis leading to stroke-induced heart injury and not of ischemic myocardial infarction. IVH additionally contributes to the proposed pathomechanism of myocardial injury.
越来越多的证据表明，自发性脑出血（sICH）且心肌肌钙蛋白（cTn）水平升高的患者预后较差。虽然孤立的cTn升高在sICH中对预后的预测价值尚不清楚，但很少有研究对cTn水平进行随访测量的患者进行研究。本研究的目的是调查高敏肌钙蛋白I（hs-cTnI）水平的动态变化与sICH患者院内结局之间的关联。
这项回顾性研究纳入了2015年至2021年间连续测量hs-cTnI水平的急性sICH患者。对hs-cTnI动态变化的患者（即随访测量时hs-cTnI水平上升或下降>20%）和hs-cTnI水平稳定的患者进行组间比较。使用多因素逻辑回归分析对怀疑影响院内死亡率的变量的预测价值进行分析。
共发现55/105例sICH患者hs-cTnI水平有动态变化。hs-cTnI水平的动态变化与院内死亡率显著相关。动态组的脑室内出血（IVH）发生率较高，而血管风险状况、冠状动脉疾病负担和入院时的功能性神经状态分布均匀。虽然hs-cTnI水平的动态变化呈现出一种趋势，但仅IVH可独立预测院内死亡率。
我们认为，hs-cTnI动态变化是sICH沿脑-心轴驱动的急性心肌“损伤”的一种表现，导致中风诱导的心脏损伤，而非缺血性心肌梗死。IVH进一步促成了所提出的心肌损伤发病机制。
