Abstract
Objective We designed a multi-centre prospective cohort study to explore the hypothesis that early acutely elevated high sensitivity troponin (hsT) is associated with cardioembolic stroke (CES)
Methods Ischaemic strokes across three hospitals underwent hsTroponin testing and 2 blinded clinicians classified patients as CES, NCE (Non Cardioembolic) or ESUS by ESUS criteria. Characteristics included baseline NIHSS, renal function, hypertension, diabetes, smoking, ischaemic heart disease, past stroke and congestive cardiac failure. The odds of positive hsT for CES Vs NCE and ESUS Vs NCE were modelled with step-wise addition of patient characteristics.
Results 194 ischaemic stroke cases were included, with a mean age of 71 years and a 57:43 male:female ratio. 65 had a positive hsTroponin, which was associated with older age, hypertension, cardiac failure, coronary disease, an eGFR < 60 and a higher NIHSS. Positive hsTroponin was associated with CES (OR, 2.06; 95% CI, 1.12-3.79; P = 0.02). This association persisted after adjusting for confounders, such as age, sex, atrial fibrillation, renal impairment, ischaemic heart disease and previous stroke (Adjusted OR, 4.07; 95% CI, 1.41–11.75; P=0.01). ESUS was negatively associated with an elevated hs troponin (OR, 0.45; 95% CI, 0.22–0.94; P=0.03). This was not significant when adjusting for other variables (P=0.09).
Conclusions An elevated hs troponin after acute ischaemic stroke is independently associated with a cardioembolic mechanism. High sensitivity cardiac troponin was not significantly associated with ESUS after adjusting for confounders, suggesting that a cardio-embolic cause may not be the dominant mechanism in this group.
