Cardiac troponin T: A sensitive and specific indicator of myocardial injury in patients with cerebrovascular stroke

• Main Authors: Mohammed Amin, Adel Gamal, Mohammed Ali, Omar Awad
• Format: Article
• Language: English
• Published: SpringerOpen 2012-09-01
• Series: The Egyptian Heart Journal
• Subjects: Troponin T; Myocardial injury; Cerebrovascular stroke
• Online Access: http://www.sciencedirect.com/science/article/pii/S1110260811000093

Background: Unsuspected morbidity and mortality in cerebrovascular stroke (CVS) patients remain a serious issue in critical medicine field. Patients with CVS are at increased risk of developing cardiac complications which explains the high morbidity and mortality rates among those patients. We examined the predictive value of cardiac troponin T (CTNT) in assessing myocardial injury and cardiac dysfunction in ischemic and hemorrhagic CVS. Methods: One hundred and twenty patients with acute CVS (78 with infarction, 42 with hemorrhage) confirmed by brain CT scan were enrolled. CTNT assay was done within 24 h of stroke onset at 0, 12, and 24 h. Levels equal to or more than 0.1 ng/mL were deemed high. Echocardiographic evaluation was done at 3rd to 5th day for new segmental wall motion abnormalities (SWMA). Twelve lead electrocardiograms (ECGs) were done on day 1, 2, 3, and 5 from stroke onset. ST segment elevation or depression ⩾1 mm, and/or T wave flattening or inversion in three leads were considered significant. Patients with history of CAD, resting ST-T wave changes were excluded. Results: CTNT was elevated in 24 patients (20%), 12 patients with infarction (15.3%), and 12 with hemorrhage (28.5%), P > 0.05. Abnormal ECGs were observed in 50 cases (12 had ST deviation, 38 had T wave changes). All troponin +ve patients showed abnormal ECG (100%), compared to only 26 patients out of the troponin −ve patients (27%) (P < 0.01). ST deviation occurred in 10 troponin +ve patients (41.6%), two troponin −ve patients (2.08%), (P < 0.01). T wave changes occurred in 14 troponin +ve patients (58.3%), 24 troponin −ve patients (25%), (P < 0.05). Resting SWMA were observed in 24 cases, all of which had +ve troponin, none of the troponin −ve patients showed SWMA (100% sensitivity, specificity, positive and negative predictive values) P < 0.001. Conclusions: Myocardial injury is not uncommon in patients with CVS. Silent ST-T wave changes and new resting SWMA are possible complications. We demonstrated highly significant correlation between positive troponin T and myocardial injury in these patients.