Elevated Cardiac Troponin T Levels May Be Associated With Cerebral Microbleeds

Researchers have found that elevated high-sensitivity cardiac troponin T (hs-cTnT) levels may be an independent predictor of cerebral microbleeds (CMBs) in patients with acute ischemic stroke who have atrial fibrillation (AFib), rheumatic heart disease, or both.

“Considering the link between atherosclerosis and CMBs,² it led us to wonder whether hs-cTnT may be a marker of subclinical small-vessel disease, such as CMBs,” wrote Junfeng Liu, MD, from the Stroke Clinical Research Unit at West China Hospital, Sichuan University in Chengdu, People’s Republic of China and colleagues. “Few studies have examined this question directly.”

The researchers evaluated 139 patients enrolled in the “Study on Small Vessel Pathological Mechanism of Cerebral Hemorrhage After Cardioembolic Stroke Using SWI markers”, carried out by the National Natural Science Foundation of China. Of those 139 patients, 66 had sufficient data and were included in this study. Mean age at stroke onset was 68.71 ± 11.31 years. Twenty-seven patients (40.9%) were men, 49 patients had only AFib, 5 had rheumatic heart disease, and 12 had both.

The researchers found that 39 patients (59.1%) had CMBs. Those with CMBs were more likely to be men, to be older, to have a history of hypertension, and to have a lower NIHSS score compared with those without CMBs.

Based on serum concentrations of hs-cTnT within 48 hours after admission, the patients were divided into tertiles:

• Tertile 1: < 10.80 ng/L
• Tertile 2: 10.80-17.78 ng/L
• Tertile 3: > 17.78 ng/L

While there was no significant association found between hs-cTnT tertiles and lobar CMBs (odds ratio [OR] = 0.67, 95% confidence interval [CI] 0.23-1.89, P = .44), logistic regression analysis found that those in the third tertile were more likely to have CMBs (OR 3.98, 95% CI 1.22-12.96, P = .02) and deep or infratentorial CMBs (OR 5.06, 95% CI 1.72-14.96, P = .003) compared with patients in the lower tertile, after adjusting for age, sex, current alcohol consumption, total cholesterol hypertension, diabetes mellitus, prior antithrombotic therapy, and patients’ admission score on the National Institutes of Health Stroke scale (NIHSS).

“In this small prospective study, we provide preliminary evidence that higher hs-cTnT levels on admission are independently associated with higher risk of CMBs and deep or infratentorial CMBs in acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease after controlling for other factors associated with hs-cTnT levels and CMB risk,” the authors wrote.

However, because the study population was small and highly specific, the researchers emphasize that further studies are needed to find out whether these results are generalizable to other populations, and to find whether there is a mechanism that specifically supports an association between higher hs-cTnT levels and CMB formation in deep regions.

“In the future, hs-cTnT may be a possible risk marker upfront of treatment decisions, especially in patients combined with detected CMBs,” the authors concluded.

References

1. Liu J, Wang D, Xiong Y, et al. High-sensitivity cardiac troponin T levels and risk of cerebral microbleeds in acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. J Neurol Sci. 2016;369:15-8. doi:10.1016/j.jns.2016.08.003. [Epub ahead of print]

2. Wardlaw JM, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet. 2013;12(5):483–497.