Background: It has been hypothesised that elevated serum troponin levels in acute stroke are due to myocardial damage caused by sympathoadrenal activation, which, in turn, may be due particularly to insular damage. We aimed to determine the factors associated with troponin elevation in ischaemic stroke and the prognostic value of this finding. Methods: We studied 222 consecutive acute ischaemic stroke admissions. Serum troponin I and catecholamines were measured. Ischaemic damage on brain computed tomography (CT) scan was graded using the Alberta Stroke Program Early CT Score (ASPECTS). Electrocardiograms were classified using the Minnesota Code and the European Society of Cardiology/American College of Cardiology criteria for acute myocardial infarction. The Rankin scale was recorded at 30 days. Results: Forty-five patients (20%) had troponin I >0.2 µg/l. These troponin-positive patients had higher epinephrine levels (median 0.27 vs. 0.17 nmol/l; p = 0.0002) and were more likely to have electrocardiograms coded as definite or possible acute myocardial infarction (odds ratio 3.35; 95% CI 1.26–8.93), compared with those with troponin ≤0.2 µg/l, in univariate analysis. There were no significant associations between troponin I score and ASPECTS or insular damage on brain CT. In logistic regression analyses, elevated troponin was significantly associated with age, elevated serum creatinine and epinephrine; however, increased troponin was not an independent predictor of death or dependency (Rankin >2) at 30 days. Conclusions: Raised troponin I is associated with elevation of circulating epinephrine in acute ischaemic stroke. Activation of the sympathoadrenal system may be an important contributor to myocardial damage in these patients. Increased troponin is not associated with insular damage and does not independently predict poor outcome.

1.
Myers MG, Norris JW, Hachinski VC, Weingert ME, Sole MJ: Cardiac sequelae of acute stroke. Stroke 1982;13:838–842.
2.
Norris JW, Hachinski VC, Myers MG, Callow J, Wong T, Moore RW: Serum cardiac enzymes in stroke. Stroke 1979;10:548–553.
3.
Ay H, Arsava EM, Saribas O: Creatine kinase-MB elevation after stroke is not cardiac in origin: comparison with troponin T levels. Stroke 2002;33:286–289.
4.
Christensen H, Johannesen HH, Christensen AF, Bendtzen K, Boysen G: Serum cardiac troponin I in acute stroke is related to serum cortisol and TNF-α. Cerebrovasc Dis 2004;18:194–199.
5.
Trooyen M, Indredavik B, Rossvoll O, Slordahl SA: Myocardial injury in acute stroke assessed by troponin I. Tidsskr Nor Laegeforen 2001;121:421–425.
6.
Di Angelantonio E, Fiorelli M, Toni D, Sacchetti ML, Lorenzano S, Falcou A, Ciarla MV, Suppa M, Bonanni L, Bertazzoni G, Aguglia F, Argentino C: Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2005;76:76–81.
7.
James P, Ellis C, Whitlock R, McNeil A, Henley J, Anderson N: Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ 2000;320:1502–1504.
8.
Ay H, Koroshetz WJ, Benner T, Vangel MG, Melinosky C, Arsava EM, Ayata C, Zhu M, Schwamm LH, Sorensen AG: Neuroanatomic correlates of stroke-related myocardial injury. Neurology 2006;66:1325–1329.
9.
Butcher KS, Parsons MW, Ay H, Arsava EM, Saribas O: Cardiac enzyme elevations after stroke: the importance of specificity. Stroke 2002;33:1944–1945.
10.
Hachinski VC, Smith KE, Silver MD, Gibson CJ, Ciriello J: Acute myocardial and plasma catecholamine changes in experimental stroke. Stroke 1986;17:387–390.
11.
Smith KE, Hachinski VC, Gibson CJ, Ciriello J: Changes in plasma catecholamine levels after insula damage in experimental stroke. Brain Res 1986;375:182–185.
12.
Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC: Cardiovascular effects of human insular cortex stimulation. Neurology 1992;42:1727–1732.
13.
Tatschl C, Stollberger C, Matz K, Yilmaz N, Eckhardt R, Nowotny M, Dachenhausen A, Brainin M: Insular involvement is associated with QT prolongation: ECG abnormalities in patients with acute stroke. Cerebrovasc Dis 2006;21:47–53.
14.
Christensen H, Boysen G, Christensen AF, Johannesen HH: Insular lesions, ECG abnormalities, and outcome in acute stroke. J Neurol Neurosurg Psychiatry 2005;76:269–271.
15.
Tokgözoglu S, Batur M, Topçuoglu M, Saribas O, Kes S, Oto A: Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999;30:1307–1311.
16.
Colivicchi F, Bassi A, Santini M, Caltagirone C: Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke 2004;35:2094–2098.
17.
Colivicchi F, Bassi A, Santini M, Caltagirone C: Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke. Stroke 2005;36:1710–1715.
18.
Etgen T, Baum H, Sander K, Sander D: Cardiac troponins and N-terminal pro-brain natriuretic peptide in acute ischemic stroke do not relate to clinical prognosis. Stroke 2005;36:270–275.
19.
Barber M, Langhorne P, Rumley A, Lowe GDO, Stott DJ: Hemostatic function and progressing ischemic stroke: D-dimer predicts early clinical progression. Stroke 2004;35:1421–1425.
20.
Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischaemic stroke – background and study protocol. Stroke 1985;16:885–890.
21.
Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–607.
22.
Myocardial infarction redefined – a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction: Eur Heart J 2000;21:1502–1513.
23.
Goldstein DS, Feuerstein G, Izzo JL Jr, Kopin IJ, Keiser HR: Validity and reliability of liquid chromatography with electrochemical detection for measuring plasma levels of norepinephrine and epinephrine in man. Life Sci 1981;28:467–475.
24.
Barber PA, Demchuk AM, Zhang J, Buchan AM: Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000;355:1670–1674.
25.
Prineas R, Crow R, Blackburn H: The Minnesota Code Manual of Electrocardiographic Findings. Littleton, Wright, 1982.
26.
Myers MG, Norris JW, Hachinski VC, Sole MJ: Plasma norepinephrine in stroke. Stroke 1981;12:200–204.
27.
Sander D, Winbeck K, Klingelhofer J, Etgen T, Conrad B: Prognostic relevance of pathological sympathetic activation after acute thromboembolic stroke. Neurology 2001;57:833–838.
28.
Norris JW, Kolin A, Hachinski VC: Focal myocardial lesions in stroke. Stroke 1980;11:130.
29.
Cheung RTF, Hachinski V: The insula and cerebrogenic sudden death. Arch Neurol 2000;57:1685–1688.
30.
Meyer S, Strittmatter M, Fischer C, Georg T, Schmitz B: Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. Neuroreport 2004;15:357–361.
31.
Cechetto DF, Chen SJ: Subcortical sites mediating sympathetic responses from insular cortex in rats. Am J Physiol 1990;258:R245–R255.
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