ReviewMechanism of Troponin Elevations in Patients With Acute Ischemic Stroke
Section snippets
Assays Used to Measure Troponin
Troponin acts as a muscle-regulatory protein and consists of 3 subunits: T, I, and C. Although cardiac troponin C, the calcium-binding subunit, is identical to the troponin C expressed in skeletal muscle, cardiac troponin I (cTnI) and cardiac troponin T (cTnT) are specific to the heart.15 Troponin appears in the bloodstream 5 to 6 hours after AMI. Peak concentrations appear after 18 to 24 hours, and, despite gradual decreases, concentrations can stay elevated for up to 10 to 14 days. Today, the
Prevalence and Causes of Troponin Elevation in Patients With Ischemic Stroke
Existing studies of troponin elevations in patients with acute ischemic stroke are listed in Table 2, Table 3. Although it seems that a large body of evidence is available, the interpretation of these studies remains unclear in clinical practice. One reason why data of cardiac markers in patients with ischemic stroke are difficult to interpret is the hypothesis that the cerebrovascular event may endanger the heart in some kind of direct manner, leading to the elevation of troponin and creatine
Evidence of Myocardial Infarction
In 2000, the European Society of Cardiology and the American College of Cardiology recognized the role of biomarkers and made elevations (increase-and-decrease patterns) in their levels the cornerstone of the diagnosis of AMI.20 With this definition in mind, only few of the stroke studies (Table 2) featured serial measurements of cardiac markers and concomitant electrocardiographic (ECG) recordings.24, 26, 31, 35, 37 In our own previous work, we identified only 7 of 244 patients (3%) with
Prognostic Value of Troponin in Acute Ischemic Stroke
Troponin elevations confer a very well defined increase of cardiovascular mortality and risk for reinfarction in patients with acute coronary syndrome.38 Currently available data in patients with acute coronary syndrome reveal no threshold below which elevations of troponin are without negative implications for prognosis.39 Similarly, the prognostic implication of troponin in patients with ischemic stroke has been scrutinized by several investigators (Table 3).22, 23, 25, 31, 32, 33, 34, 35, 37
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Cited by (0)
- 1
Dr. Jensen was supported by a grant from the Danish Heart Foundation, Copenhagen, Denmark.
- 2
Dr Atar has received grants from the National Association of Norway for Public Health (the Norwegian Council for Heart and Vessels), Olso; the Eastern Regional Health Authority of Norway, Hamar; and the Aker University Hospital Research Foundation, Oslo, Norway.