TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study
AimsIncreased high-sensitive cardiac troponin I (hs-cTnI) levels are common in patients with acute ischemic stroke. However, only a minority demonstrates culprit lesions on coronary angiography, suggesting other mechanisms, e.g., inflammation, as underlying cause of myocardial damage. Late Gadoliniu...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.989376/full |
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| author | Annerose Mengel Lilyana Nenova Karin A. L. Müller Sven Poli Markus C. Kowarik Markus C. Kowarik Katharina Feil Lars Mizera Tobias Geisler Jens Kübler Heiko Mahrholdt Ulrike Ernemann Florian Hennersdorf Ulf Ziemann Konstantin Nikolaou Meinrad Gawaz Patrick Krumm Simon Greulich |
| author_facet | Annerose Mengel Lilyana Nenova Karin A. L. Müller Sven Poli Markus C. Kowarik Markus C. Kowarik Katharina Feil Lars Mizera Tobias Geisler Jens Kübler Heiko Mahrholdt Ulrike Ernemann Florian Hennersdorf Ulf Ziemann Konstantin Nikolaou Meinrad Gawaz Patrick Krumm Simon Greulich |
| author_sort | Annerose Mengel |
| collection | DOAJ |
| description | AimsIncreased high-sensitive cardiac troponin I (hs-cTnI) levels are common in patients with acute ischemic stroke. However, only a minority demonstrates culprit lesions on coronary angiography, suggesting other mechanisms, e.g., inflammation, as underlying cause of myocardial damage. Late Gadolinium Enhancement (LGE)-cardiac magnetic resonance (CMR) with mapping techniques [T1, T2, extracellular volume (ECV)] allow the detection of both focal and diffuse myocardial abnormalities. We investigated the prevalence of culprit lesions by coronary angiography and myocardial tissue abnormalities by a comprehensive CMR protocol in troponin-positive stroke patients.Methods and resultsPatients with troponin-positive acute ischemic stroke and no history of coronary artery disease were prospectively enrolled. Coronary angiography and CMR (LGE, T1 + T2 mapping, ECV) were performed within the first days of the acute stroke. Twenty-five troponin-positive patients (mean age 62 years, 44% females) were included. 2 patients (8%) had culprit lesions on coronary angiography and underwent percutaneous coronary intervention. 13 patients (52%) demonstrated LGE: (i) n = 4 ischemic, (ii) n = 4 non-ischemic, and (iii) n = 5 ischemic AND non-ischemic. In the 12 LGE-negative patients, mapping revealed diffuse myocardial damage in additional 9 (75%) patients, with a high prevalence of increased T2 values.ConclusionsOur data show a low prevalence of culprit lesions in troponin-positive stroke patients. However, > 50% of the patients demonstrated myocardial scars (ischemic + non-ischemic) by LGE-CMR. Mapping revealed additional myocardial abnormalities (mostly inflammatory) in the majority of LGE-negative patients. Therefore, a comprehensive CMR protocol gives important insights in the etiology of troponin which might have implications for the further work-up of troponin-positive stroke patients. |
| first_indexed | 2024-04-12T17:10:42Z |
| format | Article |
| id | doaj.art-f55416f947fd43649fca79e867881432 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T17:10:42Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-f55416f947fd43649fca79e8678814322022-12-22T03:23:49ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-09-01910.3389/fcvm.2022.989376989376TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI studyAnnerose Mengel0Lilyana Nenova1Karin A. L. Müller2Sven Poli3Markus C. Kowarik4Markus C. Kowarik5Katharina Feil6Lars Mizera7Tobias Geisler8Jens Kübler9Heiko Mahrholdt10Ulrike Ernemann11Florian Hennersdorf12Ulf Ziemann13Konstantin Nikolaou14Meinrad Gawaz15Patrick Krumm16Simon Greulich17Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Cardiology and Angiology, University of Tübingen, Tübingen, GermanyDepartment of Cardiology and Angiology, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology, Technische Universität München, Munich, GermanyDepartment of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Cardiology and Angiology, University of Tübingen, Tübingen, GermanyDepartment of Cardiology and Angiology, University of Tübingen, Tübingen, GermanyDepartment of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, GermanyDepartment of Cardiology and Angiology, Robert Bosch Medical Center, Stuttgart, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, GermanyDepartment of Cardiology and Angiology, University of Tübingen, Tübingen, GermanyDepartment of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, GermanyDepartment of Cardiology and Angiology, University of Tübingen, Tübingen, GermanyAimsIncreased high-sensitive cardiac troponin I (hs-cTnI) levels are common in patients with acute ischemic stroke. However, only a minority demonstrates culprit lesions on coronary angiography, suggesting other mechanisms, e.g., inflammation, as underlying cause of myocardial damage. Late Gadolinium Enhancement (LGE)-cardiac magnetic resonance (CMR) with mapping techniques [T1, T2, extracellular volume (ECV)] allow the detection of both focal and diffuse myocardial abnormalities. We investigated the prevalence of culprit lesions by coronary angiography and myocardial tissue abnormalities by a comprehensive CMR protocol in troponin-positive stroke patients.Methods and resultsPatients with troponin-positive acute ischemic stroke and no history of coronary artery disease were prospectively enrolled. Coronary angiography and CMR (LGE, T1 + T2 mapping, ECV) were performed within the first days of the acute stroke. Twenty-five troponin-positive patients (mean age 62 years, 44% females) were included. 2 patients (8%) had culprit lesions on coronary angiography and underwent percutaneous coronary intervention. 13 patients (52%) demonstrated LGE: (i) n = 4 ischemic, (ii) n = 4 non-ischemic, and (iii) n = 5 ischemic AND non-ischemic. In the 12 LGE-negative patients, mapping revealed diffuse myocardial damage in additional 9 (75%) patients, with a high prevalence of increased T2 values.ConclusionsOur data show a low prevalence of culprit lesions in troponin-positive stroke patients. However, > 50% of the patients demonstrated myocardial scars (ischemic + non-ischemic) by LGE-CMR. Mapping revealed additional myocardial abnormalities (mostly inflammatory) in the majority of LGE-negative patients. Therefore, a comprehensive CMR protocol gives important insights in the etiology of troponin which might have implications for the further work-up of troponin-positive stroke patients.https://www.frontiersin.org/articles/10.3389/fcvm.2022.989376/fullischemic stroke (IS)troponinCMR (cardiovascular magnetic resonance)inflammationCADmyocardial scar |
| spellingShingle | Annerose Mengel Lilyana Nenova Karin A. L. Müller Sven Poli Markus C. Kowarik Markus C. Kowarik Katharina Feil Lars Mizera Tobias Geisler Jens Kübler Heiko Mahrholdt Ulrike Ernemann Florian Hennersdorf Ulf Ziemann Konstantin Nikolaou Meinrad Gawaz Patrick Krumm Simon Greulich TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study Frontiers in Cardiovascular Medicine ischemic stroke (IS) troponin CMR (cardiovascular magnetic resonance) inflammation CAD myocardial scar |
| title | TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study |
| title_full | TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study |
| title_fullStr | TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study |
| title_full_unstemmed | TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study |
| title_short | TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study |
| title_sort | troponin of unknown origin in stroke evaluated by multi component cardiac magnetic resonance imaging the trust mi study |
| topic | ischemic stroke (IS) troponin CMR (cardiovascular magnetic resonance) inflammation CAD myocardial scar |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.989376/full |
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