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Association Between Troponin Levels and Visceral Infarction in Patients with Acute Ischemic Stroke.

TitleAssociation Between Troponin Levels and Visceral Infarction in Patients with Acute Ischemic Stroke.
Publication TypeJournal Article
Year of Publication2019
AuthorsRamasamy S, Patel P, Gupta A, Okin PM, Murthy S, Navi BB, Kamel H, Merkler AE
JournalJ Stroke Cerebrovasc Dis
Volume28
Issue12
Pagination104449
Date Published2019 Dec
ISSN1532-8511
KeywordsAged, Aged, 80 and over, Biomarkers, Brain Ischemia, Embolism, Female, Humans, Infarction, Kidney, Male, Middle Aged, New York City, Predictive Value of Tests, Prevalence, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Spleen, Stroke, Troponin, Up-Regulation
Abstract

BACKGROUND: Visceral infarctions appear to be more common in patients with embolic stroke subtypes, but their relation to troponin elevation remains uncertain.

METHODS: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 to 2016, we included those with troponin measured within 24 hours from stroke onset and a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. A troponin elevation was defined as a value exceeding our laboratory's upper limit of normal (.04 ng/ mL) in the absence of a clinically recognized acute ST-segment elevation myocardial infarction. Visceral infarction was defined as a renal or splenic infarction as ascertained by a single radiologist blinded to patients' other characteristics. Multivariable logistic regression was used to evaluate the association between elevated troponin and visceral infarction.

RESULTS: Among 2116 patients registered in CAESAR from 2011 to 2016, 153 patients had both a troponin assay and a contrast-enhanced abdominal computed tomographic scan, of whom 33 (21%) had an elevated troponin and 22 (14%) had a visceral infarction. The prevalence of visceral infarction was higher among patients with an elevated troponin (30%; 95% confidence interval [CI], 16%-49%) than among patients without an elevated troponin (10%; 95% CI, 5%-17%) (P = .003). After adjustment for demographics and comorbidities, we found a significant association between elevated troponin and visceral infarction (odds ratio, 3.9; 95% CI, 1.5-10.4).

CONCLUSIONS: Among patients with acute ischemic stroke, elevated troponin was associated with visceral infarction. Our results demonstrate that poststroke troponin elevation may indicate the presence of underlying embolic sources.

DOI10.1016/j.jstrokecerebrovasdis.2019.104449
Alternate JournalJ Stroke Cerebrovasc Dis
PubMed ID31668582

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