Neuroanatomic correlates of stroke-related myocardial injury.
BACKGROUND
Myocardial injury can occur after ischemic stroke in the absence of primary cardiac causes. The neuroanatomic basis of stroke-related myocardial injury is not well understood.


OBJECTIVE
To identify regions of brain infarction associated with myocardial injury using a method free of the bias of an a priori hypothesis as to any specific location.


METHODS
Of 738 consecutive patients with acute ischemic stroke, the authors identified 50 patients in whom serum cardiac troponin T (cTnT) elevation occurred in the absence of any apparent cause within 3 days of symptom onset. Fifty randomly selected, age- and sex-matched patients with ischemic stroke without cTnT elevation served as controls. Diffusion-weighted images with outlines of infarction were co-registered to a template, averaged, and then subtracted to find voxels that differed between the two groups. Voxel-wise p values were determined using a nonparametric permutation test to identify specific regions of infarction that were associated with cTnT elevation.


RESULTS
The study groups were well balanced with respect to stroke risk factors, history of coronary artery disease, infarction volume, and frequency of right and left middle cerebral artery territory involvement. Brain regions that were a priori associated with cTnT elevation included the right posterior, superior, and medial insula and the right inferior parietal lobule. Among patients with right middle cerebral artery infarction, the insular cluster was involved in 88% of patients with and 33% without cTnT elevation (odds ratio: 15.00; 95% CI: 2.65 to 84.79).


CONCLUSIONS
Infarctions in specific brain regions including the right insula are associated with elevated serum cardiac troponin T level indicative of myocardial injury.
Ay
H
H
A.A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. hay@partners.org
Koroshetz
W J
WJ
Benner
T
T
Vangel
M G
MG
Melinosky
C
C
Arsava
E M
EM
Ayata
C
C
Zhu
M
M
Schwamm
L H
LH
Sorensen
A G
AG
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002545:Brain Ischemia / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D009202:Cardiomyopathies / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000097:blood / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000097:blood / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D010296:Parietal Lobe / Q000473:pathology / Q000503:physiopathology; D016037:Single-Blind Method; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T