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J Stroke Cerebrovasc Dis. 2014 Feb;23(2):241-8. doi: 10.1016/j.jstrokecerebrovasdis.2013.01.005. Epub 2013 Feb 8.

Prognostic value of high-sensitivity cardiac troponin T in acute ischemic stroke.

Author information

  • 1Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway. Electronic address: kashif.faiz@medisin.uio.no.
  • 2Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
  • 3Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
  • 4Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway.

Abstract

BACKGROUND:

Cardiac troponins have been investigated as prognostic markers in the setting of ischemic stroke with diverging results. A new generation of highly sensitive troponin assays have recently been developed that allow for the detection of concentrations 5 to 10 times lower than those measureable with conventional assays. The aim of this study was to determine the association between high-sensitivity cardiac troponin T (hs-cTnT) elevation on admission and mortality after acute ischemic stroke.

METHODS:

Serum concentrations of hs-cTnT were measured at the time of admission in 347 patients with acute ischemic stroke. Clinical data and background information were obtained. Total follow-up time was 1.5 ± 0.7 years, and all-cause mortality was used as the outcome measure.

RESULTS:

Median hs-cTnT on admission in the whole group was 15.2 ng/L (interquartile range [IQR] 7.5-27.8), and was higher in nonsurvivors than survivors (28.2 ng/L [IQR 15.6-39.5] vs 11.4 ng/L [IQR 6.0-21.2]; P < .001). In multivariate analysis, high hs-cTnT (the fourth quartile) was independently associated with all-cause mortality during the follow-up period, with a hazard ratio of 1.65 (95% confidence interval [CI] 1.04-2.63; P = .035). The addition of hs-cTnT as a continuous variable to the multivariate model resulted in both incremental discrimination and reclassification of patients (C-index increase from 0.819 to 0.834 [P = .007]; integrated discrimination index 0.011 [95% CI 0.001-0.021; P = .028]).

CONCLUSIONS:

Circulating hs-cTnT levels are closely associated with the risk of death in patients with acute ischemic stroke, and even levels below the upper reference limit appear to have prognostic value.

Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Acute ischemic stroke; high-sensitivity cardiac troponin T; mortality; prognosis

PMID:
23395473
[PubMed - in process]
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