title: Prognostic value of high-sensitivity cardiac troponin T in acute ischemic stroke.
abstract: BACKGROUND
  Cardiac troponins have been investigated as prognostic markers in the setting of ischemic stroke with diverging results. A new generation of highly sensitive troponin assays have recently been developed that allow for the detection of concentrations 5 to 10 times lower than those measureable with conventional assays. The aim of this study was to determine the association between high-sensitivity cardiac troponin T (hs-cTnT) elevation on admission and mortality after acute ischemic stroke.
  
  
  METHODS
  Serum concentrations of hs-cTnT were measured at the time of admission in 347 patients with acute ischemic stroke. Clinical data and background information were obtained. Total follow-up time was 1.5 ± 0.7 years, and all-cause mortality was used as the outcome measure.
  
  
  RESULTS
  Median hs-cTnT on admission in the whole group was 15.2 ng/L (interquartile range [IQR] 7.5-27.8), and was higher in nonsurvivors than survivors (28.2 ng/L [IQR 15.6-39.5] vs 11.4 ng/L [IQR 6.0-21.2]; P < .001). In multivariate analysis, high hs-cTnT (the fourth quartile) was independently associated with all-cause mortality during the follow-up period, with a hazard ratio of 1.65 (95% confidence interval [CI] 1.04-2.63; P = .035). The addition of hs-cTnT as a continuous variable to the multivariate model resulted in both incremental discrimination and reclassification of patients (C-index increase from 0.819 to 0.834 [P = .007]; integrated discrimination index 0.011 [95% CI 0.001-0.021; P = .028]).
  
  
  CONCLUSIONS
  Circulating hs-cTnT levels are closely associated with the risk of death in patients with acute ischemic stroke, and even levels below the upper reference limit appear to have prognostic value.
authors: Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway. Electronic address: kashif.faiz@medisin.uio.no.
authors: Kashif Waqar
authors: KW
authors: Faiz
authors: Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
authors: Bente
authors: B
authors: Thommessen
authors: Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
authors: Gunnar
authors: G
authors: Einvik
authors: Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
authors: Torbjørn
authors: T
authors: Omland
authors: Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
authors: Ole Morten
authors: OM
authors: Rønning
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C545568:TNNT2 protein, human; D020107:Troponin T
keywords: Acute ischemic stroke; high-sensitivity cardiac troponin T; mortality; prognosis