Association of Serum Cardiac Troponin- I and In-Hospital Outcome in Patients with Ischaemic Stroke: A Prospective Observational Study
Md. Aminul Islam *
Department of Medicine, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Muhammad Robiul Hoque
Department of Paediatric Neurosurgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Md. Mazharul Islam
Department of Neurophysiology, National institute of Neuroscience and Hospital, Dhaka, Bangladesh.
Md Ashaduzzaman
Department of Paediatric Neurology and Development, Shaheed Ziaur Rahman Medical College and Hospital, Bogura, Bangladesh.
Md. Hasan Ali
Department of Neurophysiology, National institute of Neuroscience and Hospital, Dhaka, Bangladesh.
Kazi Irfan Subhan
Department of Neurosurgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Shuvro Saha
Department of Neurosurgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: Ischaemic stroke is a severe neurological event, which is associated with significant medical complications. Cardiac manifestations are common and can impact morbidity and mortality in ischaemic stroke patients.
Methods: This prospective observational study was carried out in the department of Medicine and Neurology in Dhaka Medical College Hospital, Dhaka, Bangladesh from 1st April 2022 to 30th September, 2024. A total of 204 patients suffering from ischaemic stroke confirmed by CT scan of head were included in this study. The patients were divided into ischaemic stroke with elevated serum cardiac troponin I (cTnI) (Group I=cTnI>0.1 ng/ml; n=102) and ischaemic stroke with normal cTnI (Group II=cTnI<0.1 ng/ml; n=102) groups, based on Troponin I level measured within 72 hours of the incident.
Results: The mean age of the study population in Group I and Group II were 63.68±13.921 vs 58.75±12.694 years (p=0.001) respectively. The mean The National Institutes of Health Stroke Scale (NIHSS) Score in Group I was 7.86±4.553 and in Group II was 2.47±1.141 (p=0.001). The mean serum cTnI was 6.79±7.84 and 0.031±0.027 (p=0.001) in Group I and Group II respectively. The mean cTnI of different The Modified Rankin Scale (MRS) groups were 1.37±4.14 in independent category, 3.53±5.85 in dependent category and 11.47±9.87 in death (p=0.001) category. 65.69% patients had poor outcome (MRS-dependent and death category) where cTnI was >0.10 while only 40.20% had poor outcome where cTnI was <0.10. The difference was statistically significant between two groups (p<0.05).
Conclusion: Measurements of serum cardiac troponin I reveal a higher incidence of myocardial injury in patients with ischaemic stroke. Raised serum cardiac troponin I is associated with more severe neurological injury.
Keywords: Ischaemic Stroke, Troponin I, In- hospital outcome