Elevation of troponins as a cardioembolic etiology marker in ischemic stroke

Abstract

Ischemic stroke may be due to several mechanisms. A cardioembolism is defined as an arterial occlusion secondary to a embolus that arises from the heart in a patient with at least one risk factor or condition for the generation of this pathology. Troponins are sensitive and specific markers of heart injury. It has been noted that between 5 and 34% of patients with ischemic stroke have elevated troponins. It was decided to carry out the following study based on the hypothesis that the elevation of troponins in the first 24 hours in patients with ischemic stroke indicates the presence of cardioembolic etiologies.

The objective was to analyze the relationship between troponin elevation in the first 24 hours and the different causal etiologies of cerebrovascular disease in patients with ischemic stroke who were admitted to the National Hospital of Clinics in the city of Córdoba.

A cross-sectional analytical observational study of patients diagnosed with ischemic stroke admitted to the neurology service of the National Hospital of Clinics between March 2018 and March 2019 was carried out. 

Patients underwent a standard diagnostic evaluation of ischemic stroke. Quantitative troponin measurements were made by analysis with an integrated system of clinical chemistry and immunochemistry Dimension EXL 200 Siemens, with electrochemiluminescence method (EQLA); a negative troponin was considered any value less than 0.056 ng / mL, while a positive troponin was defined as any value greater than or equal to 0.056 ng / ml.

79 patients participated in the study of which 23 (29.11%) presented troponin elevation, without electrocardiographic signs of Acute Myocardial Infarction. An association was found between the presence of cardioembolic etiologies and troponin elevation (p <0.0001) such as atrial fibrillation, mitral stenosis, dilated cardiomyopathy, among others.

In this study we demonstrated an independent association between elevated troponin levels and the presence of embolic etiologies, compared to the presence of non-cardioembolic etiologies. Our findings suggest that elevation during the first 24 hours of cardiac troponins may represent a marker of cardioembolic etiology.