Prevalence of myocardial injury in patients after acute ischaemic stroke according to standard criteria
Michal MihalovičPetr MikulenkaHana LínkováMarek NeubergIvana ŠtětkářováTomáš PeiskerDavid LauerPetr Toušek
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Abstract This study examined the prevalence of acute and chronic myocardial injury according to standard criteria in patients after acute ischaemic stroke (AIS) and its relation to stroke severity and short-term prognosis. Between August 2020 and August 2022, 217 consecutive patients with AIS were enrolled. Plasma levels of high-sensitive cardiac troponin I (hs-cTnI) were measured in blood samples obtained at the time of admission and 24 and 48 h later. The patients were divided into three groups according to the Fourth Universal Definition of Myocardial Infarction: no injury, chronic injury, and acute injury. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later, and on the day of hospital discharge. A standard echocardiographic examination was performed within the first 7 days of hospitalization in patients with suspected abnormalities of left ventricular function and regional wall motion. Demographic characteristics, clinical data, functional outcomes, and all-cause mortality were compared between the three groups. The National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following hospital discharge were used to assess stroke severity and outcome. Elevated hs-cTnI levels were measured in 59 patients (27.2%): 34 patients (15.7%) had acute myocardial injury and 25 patients (11.5%) had chronic myocardial injury within the acute phase after ischaemic stroke. An unfavourable outcome, evaluated based on the mRS at 90 days, was associated with both acute and chronic myocardial injury. Myocardial injury was also strongly associated with all-cause death, with the strongest association in patients with acute myocardial injury, at 30 days and at 90 days. Kaplan–Meier survival curves showed that all-cause mortality was significantly higher in patients with acute and chronic myocardial injury than in patients without myocardial injury (P < 0.001). Stroke severity, evaluated with the NIHSS, was also associated with acute and chronic myocardial injury. A comparison of the ECG findings between patients with and without myocardial injury showed a higher occurrence in the former of T-wave inversion, ST segment depression, and QTc prolongation. In echocardiographic analysis, a new abnormality in regional wall motion of the left ventricle was identified in six patients. Chronic and acute myocardial injury with hs-cTnI elevation after AIS are associated with stroke severity, unfavourable functional outcome, and short-term mortality.Keywords:
Stroke
Objective:To observe the dynamic changes of serum myocardial troponin I(cTnI) in patients with acute myocardial infarction(AMI).Methods:Blood samples were respectively obtained at admission 6,12,48 hours and 10 days later from 19 patients with acute myocardial infarction and those in 118 normal subjects served as controll group.With ELISA method,the serum concentrations cTnI in the two groups were simulataneously measured by ∑960 apparatus and compared with CK-MB.Results:The rising time of serum cTnI in AMI was earlier and its duration was longer.It was superior to CK-MB in veracity,sensitivity and specificity for diagnosic of myocardial damage.Conclusion:The present study suggests that quantitative determination of serum cTnI has very important clinical value on diagnosis of acute myocardial infarction.
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Background Resource use in the acute and subacute phases after stroke depends on the degree of disability. Aims To determine if direct costs after stroke also vary by level of disability as measured using the modified Rankin scale at the chronic stage after stroke. Methods In a multicentre study, we collected acute and chronic in- and outpatient resource use in survivors of ischemic stroke stratified by levels of disability according to the modified Rankin Scale. Statistical inference on costs at each level of the modified Rankin Scale was estimated using a general linear model for the first three months, the first year, and any subsequent year after ischemic stroke. Results A total of 569 survivors of ischemic stroke with a mean age of 71.7 years were enrolled (41% female) from 10 academic and nonacademic centers. Costs varied substantially over time and with each modified Rankin Scale level. The total average costs in the first year were estimated $33,147 per patient, ranging from $9,114 for modified Rankin Scale 0 to $83,236 for modified Rankin Scale 5. In the second year, medical costs were on average $14,039, varying from $2,921 to $39,723 for patients with modified Rankin Scale 0–5. The level of disability based on the modified Rankin Scale was a major determinant of resource use, irrespective of age, gender, atrial fibrillation, and vascular risk factors. Conclusion Long-term resource use after stroke is high and is mainly driven by degree of disability as measured by the modified Rankin scale.
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Contraction of cardiac muscle is regulated by the thin filament through Ca2+ binding to the troponin C subunit of the troponin (Tn) complex, composed of troponin I (TnI), troponin T and troponin C ...
Troponin T
Troponin complex
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Dilated Cardiomyopathy
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Cardiac troponins have proved to be reliable blood biomarkers for identifying a variety of myocardial alterations in humans and animals. Recently, an ultrasensitive cTnI assay (Erenna IA) has been used to demonstrate increases in baseline cTnI resulting from drug-induced myocardial injury in rats, dogs, and monkeys, as well as to document baseline cTnI ranges in Sprague-Dawley (SD) rats. The present study was initiated to use the Erenna cTnI assay to further document baseline cTnI concentrations in normal control animals from multiple strains, including SD, Spontaneous Hypertensive (SHR), Wistar, Wistar-Kyoto (WKY), and Fisher strains. Baseline cTnI concentrations were quantified in all rats tested, and males had higher mean cTnI concentrations than females of the same strain. SHR males had the highest mean cTnI concentrations and the largest cTnI variability. Interestingly, cTnI concentrations increased in castrated SHR compared with unaltered male SHR, whereas cTnI concentrations decreased in ovariectomized SHR compared with unaltered female SHR. These results show significant differences in cTnI concentrations between strains, sexes, and noncardiac surgical alterations in control animals, and identify these as potential contributing factors to cTnI baseline variability that should be taken into account when using ultrasensitive cTnI as a biomarker to assess preclinical cardiotoxicity.
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Troponin complex
Cardiac muscle
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Every year, not less than 300 million non-cardiac surgery interventions are performed in the world. Perioperative mortality after non-cardiac surgery is estimated at 2% in patients over 45 years of age. Cardiovascular events account for half of these deaths, and most are due to perioperative myocardial infarction (MINS). The diagnosis of postoperative myocardial infarction, before the introduction of cardiac biomarkers, was based on symptoms and electrocardiographic changes and its incidence was largely underestimated. The incidence of MINS when a standard troponin assay is used ranges between 8 and 19% but increases to 20–30% with high-sensitivity troponin assays. Higher troponin values suggesting myocardial injury, both with or without a definite diagnosis of myocardial infarction, are associated with an increase in 30-day and 1-year mortality. Diagnostic and therapeutic strategies are reported.
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Assessment of troponin levels on the emergency ward Patients with myocardial infarction are at a high risk of sudden death and new cardiovascular events. For this reason, it is important to identify these patients and device treatment to reduce the risk. Patients who seek care with symptoms indicative of myocardial infarction, mainly chest pain, constitute a large proportion of patients at our emergency departments. However, only 5-10 % of these patients have myocardial infarction, whereas the majority has benign causes of their symptoms. This means that it is important not only to identify patients with myocardial infarction quickly, but also to rule out myocardial infarction and other serious disease as fast and safely as possible. With the aid of assays capable of measuring low levels of the cardiac damage biomarker troponin, so-called high-sensitive troponin assays, and several large high-quality clinical studies, myocardial infarction can now be ruled out safely and quickly. If the patient presents with a troponin T level below 5 ng/L and has a normal ECG, myocardial infarction can normally be ruled out without the need for further investigation. In this way, about 30 % of all patients who present with a suspected myocardial infarction can leave the emergency room quickly with a high degree of medical security. On the other hand, when patients present with troponin T levels above 40 ng/L, the patient should normally be admitted to the hospital. These patients are a high-risk group and constitute only 6 % of those who seek medical attention with a suspected myocardial infarction.
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