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Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke.
J Stroke Cerebrovasc Dis. 2019 Jun; 28(6):1726-1731.JS

Abstract

BACKGROUND AND PURPOSE

Cardiac biomarkers may help identify stroke mechanisms and may aid in improving stroke prevention strategies. There is limited data on the association between these biomarkers and acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). We hypothesized that cardiac biomarkers (cardiac troponin and left atrial diameter [LAD]) would be associated with the presence of LVO.

METHODS

Data were abstracted from a single center prospective AIS database over 18 months and included all patients with AIS with CT angiography of the head and neck. The presence of LVO was defined as proximal LVO of the internal carotid artery terminus, middle cerebral artery (M1 or proximal M2), or basilar artery. Univariate analyses and predefined multivariable models were performed to determine the association between cardiac biomarkers (positive troponin [troponin ≥0.1 ng/mL] and LAD on transthoracic echocardiogram) and LVO adjusting for demographic factors (age and sex), risk factors (hypertension, diabetes, hyperlipidemia, history of stroke, congestive heart failure, coronary heart disease, and smoking), and atrial fibrillation (AF).

RESULTS

We identified 1234 patients admitted with AIS; 886 patients (71.8%) had vascular imaging to detect LVO. Of those with imaging available, 374 patients (42.2%) had LVO and 207 patients (23.4%) underwent thrombectomy. There was an association between positive troponin and LVO after adjusting for age, sex and other risk factors (adjusted OR 1.69 [1.08-2.63], P = .022) and this association persisted after including AF in the model (adjusted OR 1.60 [1.02-2.53], P = 0.043). There was an association between LAD and LVO after adjusting for age, sex, and risk factors (adjusted OR per mm 1.03 [1.01-1.05], P = 0.013) but this association was not present when AF was added to the model (adjusted OR 1.01 [0.99-1.04], P = .346). Sensitivity analyses using thrombectomy as an outcome yielded similar findings.

CONCLUSIONS

Cardiac biomarkers, particularly serum troponin levels, are associated with acute LVO in patients with ischemic stroke. Prospective studies are ongoing to confirm this association and to test whether anticoagulation reduces the risk of recurrent embolism in this patient population.

Authors+Show Affiliations

Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.Division of Cardiovascular Medicine, Department of Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: shadiyaghi@yahoo.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30898447

Citation

Chang, Andrew, et al. "Cardiac Biomarkers Predict Large Vessel Occlusion in Patients With Ischemic Stroke." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 28, no. 6, 2019, pp. 1726-1731.
Chang A, Ricci B, Grory BM, et al. Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis. 2019;28(6):1726-1731.
Chang, A., Ricci, B., Grory, B. M., Cutting, S., Burton, T., Dakay, K., Jayaraman, M., Merkler, A., Reznik, M., Lerario, M. P., Song, C., Kamel, H., Elkind, M. S. V., Furie, K., & Yaghi, S. (2019). Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 28(6), 1726-1731. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.013
Chang A, et al. Cardiac Biomarkers Predict Large Vessel Occlusion in Patients With Ischemic Stroke. J Stroke Cerebrovasc Dis. 2019;28(6):1726-1731. PubMed PMID: 30898447.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke. AU - Chang,Andrew, AU - Ricci,Brittany, AU - Grory,Brian Mac, AU - Cutting,Shawna, AU - Burton,Tina, AU - Dakay,Katarina, AU - Jayaraman,Mahesh, AU - Merkler,Alexander, AU - Reznik,Michael, AU - Lerario,Michael P, AU - Song,Christopher, AU - Kamel,Hooman, AU - Elkind,Mitchell S V, AU - Furie,Karen, AU - Yaghi,Shadi, Y1 - 2019/03/19/ PY - 2018/09/06/received PY - 2019/02/11/revised PY - 2019/02/12/accepted PY - 2019/3/23/pubmed PY - 2019/6/14/medline PY - 2019/3/23/entrez KW - Troponin KW - cardiac biomarkers KW - large vessel occlusion KW - left atrial enlargement KW - stroke SP - 1726 EP - 1731 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 28 IS - 6 N2 - BACKGROUND AND PURPOSE: Cardiac biomarkers may help identify stroke mechanisms and may aid in improving stroke prevention strategies. There is limited data on the association between these biomarkers and acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). We hypothesized that cardiac biomarkers (cardiac troponin and left atrial diameter [LAD]) would be associated with the presence of LVO. METHODS: Data were abstracted from a single center prospective AIS database over 18 months and included all patients with AIS with CT angiography of the head and neck. The presence of LVO was defined as proximal LVO of the internal carotid artery terminus, middle cerebral artery (M1 or proximal M2), or basilar artery. Univariate analyses and predefined multivariable models were performed to determine the association between cardiac biomarkers (positive troponin [troponin ≥0.1 ng/mL] and LAD on transthoracic echocardiogram) and LVO adjusting for demographic factors (age and sex), risk factors (hypertension, diabetes, hyperlipidemia, history of stroke, congestive heart failure, coronary heart disease, and smoking), and atrial fibrillation (AF). RESULTS: We identified 1234 patients admitted with AIS; 886 patients (71.8%) had vascular imaging to detect LVO. Of those with imaging available, 374 patients (42.2%) had LVO and 207 patients (23.4%) underwent thrombectomy. There was an association between positive troponin and LVO after adjusting for age, sex and other risk factors (adjusted OR 1.69 [1.08-2.63], P = .022) and this association persisted after including AF in the model (adjusted OR 1.60 [1.02-2.53], P = 0.043). There was an association between LAD and LVO after adjusting for age, sex, and risk factors (adjusted OR per mm 1.03 [1.01-1.05], P = 0.013) but this association was not present when AF was added to the model (adjusted OR 1.01 [0.99-1.04], P = .346). Sensitivity analyses using thrombectomy as an outcome yielded similar findings. CONCLUSIONS: Cardiac biomarkers, particularly serum troponin levels, are associated with acute LVO in patients with ischemic stroke. Prospective studies are ongoing to confirm this association and to test whether anticoagulation reduces the risk of recurrent embolism in this patient population. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/30898447/Cardiac_Biomarkers_Predict_Large_Vessel_Occlusion_in_Patients_with_Ischemic_Stroke_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1052-3057(19)30057-6 DB - PRIME DP - Unbound Medicine ER -