title: Cardiac Vulnerability to Cerebrogenic Stress as a Possible Cause of Troponin Elevation in Stroke.
abstract: Troponin elevation with electrocardiography changes is not uncommon in patients with acute ischemic stroke; however, it is still unclear whether the mechanism of these changes is due to cardiac problems or neurally mediated myocytic damage. Thus, we investigated cardiac and neurological predictors of troponin elevation in those patients.
  
  
  
  We retrospectively analyzed medical data of the prospectively registered ischemic stroke patients on stroke registry who were admitted and underwent a serum cardiac troponin I and 12-lead electrocardiography within 24 hours of symptom onset. However, patients with well-known troponin-elevating comorbidities were excluded from the analysis. Among 1404 ischemic stroke patients, 121 (8.7%) had elevated troponin, which was defined as more than 0.04 mg/mL. Multivariable analysis identified electrocardiography abnormalities such as QTc-prolongation (odds ratio [OR]: 1.52, 95% CI: 1.02-2.28), left ventricular hypertrophy (OR: 2.14, 95% CI 1.43-3.19), Q-wave (OR: 2.53, 95% CI: 1.48-4.32), and ST elevation (OR: 2.74, 95% CI: 1.12-6.72) as cardiac variables associated with troponin elevation, and higher National Institutes of Health Stroke Scale score (OR: 1.04, 95% CI: 1.01-1.07) and insular cortical lesions (OR: 2.78, 95% CI: 1.85-4.19) as neurological variables associated with troponin elevation. Incidence of troponin elevation as well as QTc-prolongation was increased further in combination with cardiac and neurological factors.
  
  
  
  Certain cardiac and neurological conditions in acute ischemic stroke may contribute to troponin elevation. The proposed concept of cardiac vulnerability to cerebrogenic stress can be a practical interpretation of troponin elevation and electrocardiography abnormalities in stroke patients.
authors: Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Sung-Ho
authors: SH
authors: Ahn
authors: Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Young-Hak
authors: YH
authors: Kim
authors: Medical School, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Chol-Ho
authors: CH
authors: Shin
authors: Clinical Research Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Ji-Sung
authors: JS
authors: Lee
authors: Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Bum-Joon
authors: BJ
authors: Kim
authors: Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Yeon-Jung
authors: YJ
authors: Kim
authors: Department of Neurology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors: Sang-Mi
authors: SM
authors: Noh
authors: Department of Neurology, Veterans Health Service Medical Center, Seoul, South Korea.
authors: Seung-Min
authors: SM
authors: Kim
authors: Department of Neurology, Chosun University Hospital, Gwangju, South Korea.
authors: Hyun-Goo
authors: HG
authors: Kang
authors: Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Dong-Wha
authors: DW
authors: Kang
authors: Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors: Jong S
authors: JS
authors: Kim
authors: Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea sunkwon7@gmail.com.
authors: Sun U
authors: SU
authors: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000097:blood* / Q000503:physiopathology; D002545:Brain Ischemia / Q000097:blood* / Q000503:physiopathology; D002540:Cerebral Cortex / Q000098:blood supply*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000503:physiopathology; D019210:Troponin I / Q000097:blood*; D055815:Young Adult
chemical_list: D019210:Troponin I
keywords: cardiac disease; electrocardiography; infarction; insular; troponin