P3713. Positive troponin levels and electrocardiographic findings in acute ischemic stroke

Abstract

Background: Troponin elevation and ECG changes are frequent findings in patients with acute ischemic stroke (AIS). The pathophysiology of these findings is still debated. Purpose: To assesss the prevalence of electrocardiographic (ECG) changes and troponin elevation in AIS and to determine if these findings correlate with stroke severity. Methods: Observational, retrospective study among AIS patients admitted to our stroke unit between October 2016 and December 2018. ECG was performed at admission and 24 hours later. Troponin levels were obtained after 6 hours of stroke symptoms onset. The NIH Stroke Scale (NIHSS) was performed by stroke neurologists. Results: We included 744 consecutive patients (58% male), aged 66.8 years ±16.6 SD. Main vascular risk factors were hypertension (62%), dyslipidemia (49%), type 2 diabetes (18%), smoking (16%) and coronary artery disease (CAD) (17%). Twelve patients (1.6%) died during the hospitalization. Almost a half of patients (48.7%) had abnormal ECG. The most frequent ECG findings were: long QTc (26%), pathologic Q wave (18%), atrial fibrillation (AF) (9.4%), T wave inversion (5%), left-bundle bunch block (LBBB) (4%) and ST segment depression (2%). Patients who had a history of CAD had abnormal ECG findings more frequently than those who had not. (71% vs 44%, p<0.001). Thirteen percent of patients had positive troponin levels and 6% presented severe strokes (defined as a NIHSS >15). In the univariate analysis, positive troponin was associated with ST segment depression (p=0.01), T wave inversion (p<0.01), LBBB (p<0.01) and AF (p<0.01). Patients with severe strokes had more frequent ECG abnormalities (p=0.002) and positive troponin levels (p<0.001). LBBB and AF were also associated with severe stroke (p=0.002 and p<0.0001 respectively). Conclusions: ECG changes are prevalent in acute stroke. T wave inversion, ST segment depression, AF and LBBB are associated with high troponin levels, potentially suggesting underlying CAD. High troponin levels, LBBB and AF are associated with severe stroke. Patients with acute stroke may have underlying cardiovascular disease and may benefit from cardiologic evaluation.