title: Prognostic relevance of cardiac troponin T levels and their dynamic changes measured with a high-sensitivity assay in acute ischaemic stroke: analyses from the TRELAS cohort.
abstract: OBJECTIVE
  To assess the prognostic relevance of cardiac troponin T (cTnT) values and their serial changes as measured with a high-sensitivity assay in acute ischaemic stroke.
  
  
  RESULTS
  In total, 1016 consecutive acute ischaemic stroke patients were registered prospectively within a two-year period. High-sensitivity cTnT was quantitated on admission and the following day. Patients were stratified into three groups: below the 99 th percentile of a healthy reference population (< 14 ng/l; n = 409), moderately elevated cTnT (below the median of remaining patients, 14-30 ng/l; n=299) and high cTnT (> 30 ng/l; n = 308). Outcome measures were unfavourable outcome (modified Rankin Scale ≥ 2 at hospital discharge, n=604) and in-hospital mortality (n = 36). Peak cTnT levels were significantly associated with unfavourable outcome (adjusted odds ratios versus reference for moderately elevated cTnT 1.7, 95% confidence interval [CI] 1.1-2.7 and for high cTnT 3.1, 95% CI 1.8-5.6). The optimal cut-off for determining unfavourable outcome proved to be 16 ng/l. Adding this cut-off to clinical variables led to a significant improvement of c-statistics (0.851 versus 0.838, p=0.02). Dynamic changes (δ ≥ 50%) of cTnT were detected in 137 patients (13%). Multiple Cox regression analysis showed an independent association of dynamic changes in cTnT with in-hospital mortality (hazard ratio 2.3, 95% CI 1.1-4.7). The model-fitting (p<0.001) and c-statistics (0.889 versus 0.863, p = 0.08) improved most after dynamic change in cTnT had been added to a regression model which included clinical variables alone.
  
  
  CONCLUSIONS
  Our study adds novel findings relevant for interpretation of highly sensitive cTnT assays in acute ischaemic stroke: a) Myocardial injury is detectable in more than half of patients; b) even moderately elevated cTnT is associated with unfavourable outcome (optimal cut-off 16 ng/l); and c) dynamic changes in cTnT indicate an increased risk of in-hospital death.
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Excellence Cluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: jan-friedrich.scheitz@charite.de.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Scheitz
authors.affiliation: Medizinische Klinik für Kardiologie und Pulmologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Hans-C
authors.initials: HC
authors.lastname: Mochmann
authors.affiliation: Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Hebun
authors.initials: H
authors.lastname: Erdur
authors.affiliation: Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Serdar
authors.initials: S
authors.lastname: Tütüncü
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Karl Georg
authors.initials: KG
authors.lastname: Haeusler
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department for Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.affiliation: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Excellence Cluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Charité - Universitätsmedizin Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Dynamics; High-sensitivity assay; Ischaemic stroke; Mortality; Outcome; Troponin