Background: Newly developed troponin assays have superior diagnostic and prognostic performance in acute coronary syndrome (ACS), when compared to conventional troponin assays; however, highly sensitive troponin has not been evaluated in patients with acute ischemic stroke. Methods: Highly sensitive troponin T (hsTnT) was measured daily during the first 4 days in 193 consecutive patients with acute ischemic stroke without overt ACS or atrial fibrillation. The patients were previously tested normal with a fourth-generation TnT assay. The patients were followed for 47 months, with all-cause and cardiovascular mortality end-points. Results: A total of 33.7% of the patients had hsTnT levels >14 ng/l following admission. Patients with increased hsTnT were older, had decreased hemoglobin levels and increased creatinine, NT-proBNP and CRP levels. hsTnT concentrations at admission were significantly higher in decedents than in survivors. After adjustment for stroke severity, C-reactive protein, age, NT-proBNP and prior heart and/or renal failure, hsTnT levels were not a significant predictor of long-term all-cause or cardiovascular mortality. Conclusion: Elevated levels of hsTnT are frequently present in patients with acute ischemic stroke previously tested normal with a fourth-generation TnT assay. hsTnT did not provide additional prognostic information in these subjects.

Keywords:
Highly sensitive troponin, Acute ischemic stroke, Long-term prognosis
1.
Thom T, Haase N, Rosamond W, et al: Heart disease and stroke statistics – 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006;113:e85–e151.
2.
Packard RR, Libby P: Inflammation in atherosclerosis: from vascular biology to biomarker discovery and risk prediction. Clin Chem 2008;54:24–38.
3.
Di Angelantonio E, Fiorelli M, Toni D, et al: Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2005;76:76–81.
4.
James P, Ellis CJ, Whitlock RM, McNeil AR, Henley J, Anderson NE: Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ 2000;320:1502–1504.
5.
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.
6.
Scheitz JF, Endres M, Mochmann HC, Audebert HJ, Nolte CH: Frequency, determinants and outcome of elevated troponin in acute ischemic stroke patients. Int J Cardiol 2012;157:239–242.
7.
Panteghini M: The measurement of cardiac markers: where should we focus? Am J Clin Pathol 2002;118:354–361.
8.
Keller T, Zeller T, Peetz D, et al: Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009;361:868–877.
9.
Ivandic BT, Spanuth E, Kleber M, Grammer TB, Marz W: High-sensitivity troponin T improves the prognostic value of N-terminal pro-B-type natriuretic peptide in patients with stable coronary artery disease: results from the LURIC Study. Clin Chem Lab Med 2011;49:1053–1058.
10.
Thygesen K, Mair J, Katus H, et al: Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J 2010;31:2197–2204.
11.
Baker JO, Reinhold J, Redwood S, Marber MS: Troponins: redefining their limits. Heart 2011;97:447–452.
12.
Thygesen K, Alpert JS, White HD: Universal definition of myocardial infarction. Eur Heart J 2007;28:2525–2538.
13.
Jensen JK, Kristensen SR, Bak S, Atar D, Hoilund-Carlsen PF, Mickley H: Frequency and significance of troponin T elevation in acute ischemic stroke. Am J Cardiol 2007;99:108–112.
14.
Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischemic stroke – background and study protocol. Stroke 1985;16:885–890.
15.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C: Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–1526.
16.
Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA: Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 2010;56:254–261.
17.
Stroke 1989: Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and Other Cerebrovascular Disorders. Stroke 1989;20:1407–1431.
18.
Jensen JK, Hallen J, Lund T, et al: Troponin I degradation in serum of patients with acute ischemic stroke. Scand J Clin Lab Invest 2011;71:74–80.
19.
Januzzi JL Jr, Bamberg F, Lee H, et al: High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography. Circulation 2010;121:1227–1234.
20.
De Lemos JA, Drazner MH, Omland T, et al: Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA 2010;304:2503–2512.
21.
Jensen JK, Atar D, Mickley H: Mechanism of troponin elevations in patients with acute ischemic stroke. Am J Cardiol 2007;99:867–870.
22.
Sandhu R, Aronow WS, Rajdev A, et al: Relation of cardiac troponin I levels with in-hospital mortality in patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Am J Cardiol 2008;102:632–634.
23.
Ay H, Koroshetz WJ, Benner T, et al: Neuroanatomic correlates of stroke-related myocardial injury. Neurology 2006;66:1325–1329.
24.
Barber M, Morton JJ, Macfarlane PW, Barlow N, Roditi G, Stott DJ: Elevated troponin levels are associated with sympathoadrenal activation in acute ischaemic stroke. Cerebrovasc Dis 2006;23:260–266.
25.
Kelley WE, Januzzi JL, Christenson RH: Increases of cardiac troponin in conditions other than acute coronary syndrome and heart failure. Clin Chem 2009;55:2098–2112.
26.
Reichlin T, Hochholzer W, Bassetti S, et al: Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009;361:858–867.
27.
Latini R, Masson S, Anand IS, et al: Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation 2007;116:1242–1249.
28.
Omland T, de Lemos JA, Sabatine MS, et al: A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med 2009;361:2538–2547.
29.
DeFilippi CR, de Lemos JA, Christenson RH, et al: Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA 2010;304:2494–2502.
30.
Lankeit M, Friesen D, Aschoff J, et al: Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism. Eur Heart J 2010;31:1836–1844.
31.
Ghali J, Allison D, Kleinig T, et al: Elevated serum concentrations of troponin T in acute stroke: what do they mean? J Clin Neurosci 2010;17:69–73.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.