EXPRESS: Elevation of cardiac biomarkers in stroke is associated with pathological findings on cardiac MRI – results of the HEBRAS study

It is your doctor's responsibility to get a cardiologist involved in your treatment, assuming that your hospital has a protocol to do this testing(bad assumption).  A 21% incidence rate should be enough to have a protocol created on testing for this, if your hospital is competent at all.

EXPRESS: Elevation of cardiac biomarkers in stroke is associated with pathological findings on cardiac MRI – results of the HEBRAS study

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Regina Irene Freiin von Rennenberg, Juliane Herm, Thomas Krause, ...

First Published April 11, 2022 Research Article 

https://doi.org/10.1177/17474930221095698

Article information

Abstract

Introduction

Cardiac biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT), are frequently elevated in ischemic stroke patients but the mechanisms underlying this elevation are insufficiently understood. We determined the presence of cardiac damage, assessed using cardiac MRI (CMR), in stroke patients with elevated hs-cTnT and brain natriuretic peptide (BNP).

Methods

This is a post-hoc analysis of the prospective, investigator-initiated, cross-sectional HEBRAS (HEart and BRain interfaces in Acute Stroke) study. All patients underwent measurement of hs-cTnT and BNP as well as gadolinium-enhanced CMR in the acute phase of ischemic stroke. We performed unadjusted and adjusted logistic regression models to assess the association between hs-cTnT and BNP elevation and the presence of pathological CMR findings.

Results

Two hundred and thirty three stroke patients (median age 67 years, 33% female) were included, of whom 43 (21%) had elevated hs-cTnT and 109 (47%) had elevated BNP. 100 of the 233 (43%) patients had pathological findings on CMR had focal fibrosis as detected by late-gadolinium enhancement (LGE) in 51 (23%), left-ventricular hypertrophy (LVH) in 38 (16%), reduced LVEF in 32 (14%) and left atrial dilatation in 34 (15%). After adjustment for potential confounders, both hs-cTnT (adjOR 5.0 (95%CI 2.1-11.7), p<0.001) and BNP (adjOR 4.1 (95%CI 2.3-7.3), p<0.001) were significantly associated with pathological findings on CMR. Hs-cTnT was associated with LGE, LVEF and LVH, whereas BNP was associated with left atrial dilatation and LVEF, LVH.

Conclusion

Elevated cardiac biomarkers in acute stroke including CMR are strongly associated with pathological findings on CMR. In acute stroke patients, elevation of cardiac biomarkers may identify patients who require a more thorough cardiology work-up.

Keywords

heart and brain axis, mild ischemic stroke, cardiovascular MRI, troponin, natriuretic peptides, Risk factors

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