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High-sensitivity cardiac troponin T and severity of cerebral white matter lesions in patients with acute ischemic stroke

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Abstract

Introduction

Cardiac troponin (hs-cTnT) is a sensitive marker of myocardial injury and has been linked to incident dementia. The underlying mechanism of that observation is still unknown. Given that severity of cerebral small vessel disease is a predictor of cognitive decline, we aimed to explore whether there is an association between hs-cTnT and severity of white matter lesions (WML) as a marker of cerebral small vessel disease in patients with ischemic stroke.

Methods

We analyzed consecutive acute ischemic stroke patients admitted to Charité-University Hospital, Berlin from 2011 to 2013. Severity of WML was graded on 3T-MRI using the age-related white matter severity score (ARWMS). Patients with hs-cTnT elevation suggestive of acute coronary syndrome (ACS) were excluded (hs-cTnT > 52 ng/l or dynamic change of hs-cTnT > 50%, ESC guideline). We performed unadjusted and adjusted quantile regression models to assess the association between increased hs-cTnT (dichotomized at the 99th percentile, 14 ng/l) and severity of WML.

Results

A total of 860 patients was analyzed (median age 73 years, 44.8% female, median ARWMS 6). Patients with elevated hs-cTnT had more extensive WML than those without (median ARWMS 8 vs. 5, adjusted beta for 50th percentile 1.12, 95% CI 0.41–1.84). The association between WML and hs-cTnT elevation was strongest in patients with severe WML (adjusted beta 1.77, 95% CI 0.26–3.27 for 80th WML percentile).

Conclusion

Elevated hs-cTnT levels were associated with extent of WML in acute stroke patients. Further studies are needed to assess whether hs-cTnT can be used to identify stroke patients at risk for cognitive decline.

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Author information

Author notes

    Authors and Affiliations

    1. Klinik für Neurologie, Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité-Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

      Regina von Rennenberg, Ramanan Ganeshan, Heinrich J. Audebert, Matthias Endres, Christian H. Nolte & Jan F. Scheitz

    2. Center for Stroke Research, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany

      Bob Siegerink, Ramanan Ganeshan, Kersten Villringer, Wolfram Doehner, Heinrich J. Audebert, Matthias Endres, Christian H. Nolte & Jan F. Scheitz

    3. Berlin-Brandenburg Center for Regenerative Therapies, Charite Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany

      Wolfram Doehner

    4. Medizinische Klinik mit Schwerpunkt Kardiologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

      Wolfram Doehner

    5. German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislaufforschung), Partner Site Berlin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

      Matthias Endres & Jan F. Scheitz

    6. German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen), Partner Site Berlin, Charitéplatz 1, 10117, Berlin, Germany

      Matthias Endres

    7. Berlin Institute of Health, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany

      Matthias Endres, Christian H. Nolte & Jan F. Scheitz

    Authors
    1. Regina von Rennenberg
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    2. Bob Siegerink
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    3. Ramanan Ganeshan
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    4. Kersten Villringer
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    5. Wolfram Doehner
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    6. Heinrich J. Audebert
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    7. Matthias Endres
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    8. Christian H. Nolte
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    9. Jan F. Scheitz
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    Corresponding author

    Correspondence to Regina von Rennenberg.

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    The authors declare that they have no conflict of interest.

    Ethical approval

    The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. Since we analysed only anonymised patient data that were obtained during clinical routine no informed consent had to be provided and consultation of the institutional review board was not required.

    Additional information

    Christian H. Nolte and Jan F. Scheitz contributed equally.

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    von Rennenberg, R., Siegerink, B., Ganeshan, R. et al. High-sensitivity cardiac troponin T and severity of cerebral white matter lesions in patients with acute ischemic stroke. J Neurol 266, 37–45 (2019). https://doi.org/10.1007/s00415-018-9085-3

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    • DOI: https://doi.org/10.1007/s00415-018-9085-3

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