TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging - The TRUST-MI study

Annerose Mengel; Lilyana Nenova; Karin A L Müller; Sven Poli; 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

doi:10.3389/fcvm.2022.989376

TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging - The TRUST-MI study

Front Cardiovasc Med. 2022 Sep 30:9:989376. doi: 10.3389/fcvm.2022.989376. eCollection 2022.

Authors

Annerose Mengel¹, Lilyana Nenova², Karin A L Müller², Sven Poli¹, Markus C Kowarik^{1

3}, Katharina Feil¹, Lars Mizera², Tobias Geisler², Jens Kübler⁴, Heiko Mahrholdt⁵, Ulrike Ernemann⁶, Florian Hennersdorf⁶, Ulf Ziemann¹, Konstantin Nikolaou⁴, Meinrad Gawaz², Patrick Krumm⁴, Simon Greulich²

Affiliations

¹ Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
² Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany.
³ Department of Neurology, Technische Universität München, Munich, Germany.
⁴ Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany.
⁵ Department of Cardiology and Angiology, Robert Bosch Medical Center, Stuttgart, Germany.
⁶ Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany.

Abstract

Aims: Increased 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 results: Patients 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.

Conclusions: Our 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.

Keywords: CAD; CMR (cardiovascular magnetic resonance); inflammation; ischemic stroke (IS); myocardial scar; troponin.