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Confirmation With Cardiac Troponin I

Sanjay Dixit, MD; Martha Castle, RN; Raja P. Velu, PhD; Lynn Swisher, MD; Charles Hodge, MD; Allan S. Jaffe, MD

Arch Intern Med. 2000;160:3153-3158.

Background  Patients with acute neurologic illness often manifest findings suggestive of cardiac injury. Their proper interpretation is unclear. Accordingly, we conducted a blinded evaluation to assess the incidence of cardiac injury determined by elevations of cardiac troponin I (cTnI) in patients presenting within 24 hours of a neurologic event and to determine their short- and long-term prognostic effect.

Methods  Blood samples for measurement of cTnI levels were obtained on hospital admission and daily for 3 days and were run by immunoassay. Extensive clinical evaluations including electrocardiograms and echocardiograms were obtained from all patients; daily follow-up evaluations were performed. The clinical electrocardiographic, echocardiographic, and biochemical data were analyzed independently by blinded observers.

Results  Peak levels of cTnI were elevated (0.4 µg/L) in 17 patients (19%) (mean + SD, 2.5 + 2.7 µg/L). All patients with elevated cTnI levels had clinical, electrocardiographic, or echocardiographic evidence of cardiac injury except those (n = 5) with minor elevations. One-year mortality was 29% (23/80). Early death (30 days) accounted for 44% of total mortality (n = 10) and was significantly higher in patients with elevated cTnI levels (Wilcoxon P = .01; odds ratio, 6.4). This difference was less marked by 1 year (Wilcoxon P = .07).

Conclusions  There is a substantial prevalence of myocardial injury in patients with acute neurologic illness. Cardiac injury in this population, as in others, seems to adversely affect prognosis.

From the Department of Medicine, Cardiovascular Division (Drs Dixit, Swisher, and Jaffee and Ms Castle), and Department of Neurosurgery (Dr Hodge), State University of New York Health Science Center at Syracuse; and the School of Management, Syracuse University (Dr Velu). Dr Jaffe is a consultant for Dade Behring Inc, Dover, Del. Dr Jaffe is now with the Mayo Clinic, Rochester, Minn.

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