Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2011

Open Access 01-12-2011 | Study protocol

Troponin elevation in acute ischemic stroke (TRELAS) - protocol of a prospective observational trial

Authors: Jan F Scheitz, Hans-Christian Mochmann, Christian H Nolte, Karl G Haeusler, Heinrich J Audebert, Peter U Heuschmann, Ulrich Laufs, Bernhard Witzenbichler, Heinz-Peter Schultheiss, Matthias Endres

Published in: BMC Neurology | Issue 1/2011

Login to get access

Abstract

Background

Levels of the cardiac muscle regulatory protein troponin T (cTnT) are frequently elevated in patients with acute ischemic stroke and elevated cTnT predicts poor outcome and mortality. The pathomechanism of troponin release may relate to co-morbid coronary artery disease and myocardial ischemia or, alternatively, to neurogenic cardiac damage due to autonomic activation after acute ischemic stroke. Therefore, there is uncertainty about how acute ischemic stroke patients with increased cTnT levels should be managed regarding diagnostic and therapeutic workup.

Methods/Design

The primary objective of the prospective observational trial TRELAS (TRoponin ELevation in Acute ischemic Stroke) is to investigate the frequency and underlying pathomechanism of cTnT elevation in acute ischemic stroke patients in order to give guidance for clinical practice. All consecutive patients with acute ischemic stroke admitted within 72 hours after symptom onset to the Department of Neurology at the Campus Benjamin Franklin of the University Hospital Charité will be screened for cTnT elevations (i.e. >= 0.05 μg/l) on admission and again on the following day. Patients with increased cTnT will undergo coronary angiography within 72 hours. Diagnostic findings of coronary angiograms will be compared with age- and gender-matched patients presenting with Non-ST-Elevation myocardial infarction to the Department of Cardiology. The primary endpoint of the study will be the occurrence of culprit lesions in the coronary angiogram indicating underlying co-morbid obstructive coronary artery disease. Secondary endpoints will be the localization of stroke in the cerebral imaging and left ventriculographic findings of wall motion abnormalities suggestive of stroke-induced global cardiac dysfunction.

Discussion

TRELAS will prospectively determine the frequency and possible etiology of troponin elevation in a large cohort of ischemic stroke patients. The findings are expected to contribute to clarify pathophysiologic concepts of co-morbid cardiac damage in ischemic stroke patients and also to provide a basis for clinical recommendations for cardiac workup of such patients.

Trial registration

clinicaltrials.gov NCT01263964
Appendix
Available only for authorised users
Literature
1.
Jespersen CM, Fischer Hansen J: Myocardial stress in patients with acute cerebrovascular events. Cardiology. 2008, 110: 123-128. 10.1159/000110491.CrossRefPubMed
2.
Jensen JK, Atar D, Mickley H: Mechanism of troponin elevations in patients with acute ischemic stroke. Am J Cardiol. 2007, 99: 867-870. 10.1016/j.amjcard.2006.10.052.CrossRefPubMed
3.
4.
Daubert MA, Jeremias A: The utility of troponin measurement to detect myocardial infarction: review of the current findings. Vasc Health Risk Manag. 2010, 6: 691-699.PubMedPubMedCentral
5.
Jeremias A, Gibson CM: Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded. Ann Intern Med. 2005, 142: 786-791.CrossRefPubMed
6.
Agewall S, Giannitsis E, Jernberg T, Katus H: Troponin elevation in coronary vs. non-coronary disease. Eur Heart J. 2011, 32: 404-411. 10.1093/eurheartj/ehq456.CrossRefPubMed
7.
Freda BJ, Tang WHW, van Lente F, Peacock WF, Francis GS: Cardiac troponins in renal insufficiency: review and clinical implications. J Am Coll Cardiol. 2002, 40: 2065-2071. 10.1016/S0735-1097(02)02608-6.CrossRefPubMed
8.
Kerr G, Ray G, Wu O, Stott DJ, Langhorne P: Elevated troponin after stroke: a systematic review. Cerebrovasc Dis. 2009, 28: 220-226. 10.1159/000226773.CrossRefPubMed
9.
James P, Ellis CJ, Whitlock RM, McNeil AR, Henley J, Anderson NE: Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ. 2000, 320: 1502-1504. 10.1136/bmj.320.7248.1502.CrossRefPubMedPubMedCentral
10.
Di Angelantonio E, Fiorelli M, Toni D, Sacchetti ML, Lorenzano S, Falcou A, Ciarla MV, Suppa M, Bonanni L, Bertazzoni G, Aguglia F, Argentino C: Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatr. 2005, 76: 76-81. 10.1136/jnnp.2004.041491.CrossRefPubMed
11.
Jensen JK, Kristensen SR, Bak S, Atar D, Høilund-Carlsen PF, Mickley H: Frequency and significance of troponin T elevation in acute ischemic stroke. Am J Cardiol. 2007, 99: 108-112. 10.1016/j.amjcard.2006.07.071.CrossRefPubMed
12.
Ay H, Koroshetz WJ, Benner T, Vangel MG, Melinosky C, Arsava EM, Ayata C, Zhu M, Schwamm LH, Sorensen AG: Neuroanatomic correlates of stroke-related myocardial injury. Neurology. 2006, 66: 1325-1329. 10.1212/01.wnl.0000206077.13705.6d.CrossRefPubMed
13.
Amarenco P, Lavallée PC, Labreuche J, Ducrocq G, Juliard J, Feldman L, Cabrejo L, Meseguer E, Guidoux C, Adraï V, Ratani S, Kusmierek J, Lapergue B, Klein IF, Gongora-Rivera F, Jaramillo A, Mazighi M, Touboul P, Steg PG: Prevalence of Coronary Atherosclerosis in Patients With Cerebral Infarction. Stroke. 2010, 42: 22-29.CrossRefPubMed
14.
Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, Naritomi H, Minematsu K: Takotsubo cardiomyopathy in acute ischemic stroke. Ann Neurol. 2008, 64: 547-554. 10.1002/ana.21459.CrossRefPubMed
15.
Iltumur K, Yavavli A, Karabulut A, Apak I, Aluclu U, Ariturk Z, Toprak N: Elevated plasma N-terminal pro-brain natriuretic peptide levels in acute ischemic stroke. Am Heart J. 2006, 151: 1115-1122. 10.1016/j.ahj.2005.05.022.CrossRefPubMed
16.
Ambrose JA, Winters SL, Stern A, Eng A, Teichholz LE, Gorlin R, Fuster V: Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol. 1985, 5: 609-616. 10.1016/S0735-1097(85)80384-3.CrossRefPubMed
17.
Ambrose JA, Israel DH: Angiography in unstable angina. Am J Cardiol. 1991, 68: 78B-84B. 10.1016/0002-9149(91)90388-2.CrossRefPubMed
18.
Braunwald E: Unstable angina. A classification. Circulation. 1989, 80: 410-414. 10.1161/01.CIR.80.2.410.CrossRefPubMed
19.
Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V: Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989, 20: 864-870. 10.1161/01.STR.20.7.864.CrossRefPubMed
20.
Goldstein LB, Bertels C, Davis JN: Interrater reliability of the NIH stroke scale. Arch Neurol. 1989, 46: 660-662.CrossRefPubMed
21.
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988, 19: 604-607. 10.1161/01.STR.19.5.604.CrossRefPubMed
22.
Banks JL, Marotta CA: Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007, 38: 1091-1096. 10.1161/01.STR.0000258355.23810.c6.CrossRefPubMed
23.
Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993, 24: 35-41. 10.1161/01.STR.24.1.35.CrossRefPubMed
24.
Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, Biedert S, Schaub N, Buerge C, Potocki M, Noveanu M, Breidthardt T, Twerenbold R, Winkler K, Bingisser R, Mueller C: Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009, 361: 858-867. 10.1056/NEJMoa0900428.CrossRefPubMed
25.
Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA: Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem. 2010, 56: 254-261. 10.1373/clinchem.2009.132654.CrossRefPubMed
26.
Prasad A, Lerman A, Rihal CS: Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008, 155: 408-417. 10.1016/j.ahj.2007.11.008.CrossRefPubMed
27.
Laufs U, Hoppe UC, Rosenkranz S, Kirchhof P, Böhm M, Diener H, Endres M, Grond M, Hacke W, Meinertz T, Ringelstein EB, Röther J, Dichgans M: Cardiological evaluation after cerebral ischaemia. Consensus statement of the Working Group Heart and Brain of the German Cardiac Society-Cardiovascular Research (DGK) and the German Stroke Society (DSG). Clin Res Cardiol. 2010, 99: 609-625. 10.1007/s00392-010-0200-4.CrossRefPubMed
28.
Hotter B, Pittl S, Ebinger M, Oepen G, Jegzentis K, Kudo K, Rozanski M, Schmidt WU, Brunecker P, Xu C, Martus P, Endres M, Jungehülsing GJ, Villringer A, Fiebach JB: Prospective study on the mismatch concept in acute stroke patients within the first 24 h after symptom onset - 1000Plus study. BMC Neurol. 2009, 9: 60-10.1186/1471-2377-9-60.CrossRefPubMedPubMedCentral
29.
Gehrie ER, Reynolds HR, Chen AY, Neelon BH, Roe MT, Gibler WB, Ohman EM, Newby LK, Peterson ED, Hochman JS: Characterization and outcomes of women and men with non-ST-segment elevation myocardial infarction and nonobstructive coronary artery disease: results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. Am Heart J. 2009, 158: 688-694. 10.1016/j.ahj.2009.08.004.CrossRefPubMed
30.
Bassand J, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernández-Avilés F, Fox KAA, Hasdai D, Ohman EM, Wallentin L, Wijns W: Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007, 28: 1598-1660.CrossRefPubMed
31.
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B: ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007, 116: e148-304.CrossRefPubMed
32.
Mehta SR, Granger CB, Boden WE, Steg PG, Bassand J, Faxon DP, Afzal R, Chrolavicius S, Jolly SS, Widimsky P, Avezum A, Rupprecht H, Zhu J, Col J, Natarajan MK, Horsman C, Fox KAA, Yusuf S: Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009, 360: 2165-2175. 10.1056/NEJMoa0807986.CrossRefPubMed
33.
Sheifer SE, Manolio TA, Gersh BJ: Unrecognized myocardial infarction. Ann Intern Med. 2001, 135: 801-811.CrossRefPubMed
34.
de Torbal A, Boersma E, Kors JA, van Herpen G, Deckers JW, van der Kuip DAM, Stricker BH, Hofman A, Witteman JCM: Incidence of recognized and unrecognized myocardial infarction in men and women aged 55 and older: the Rotterdam Study. Eur Heart J. 2006, 27: 729-736. 10.1093/eurheartj/ehi707.CrossRefPubMed
35.
Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, Stewart-Wynne EG: Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke. 2000, 31: 2080-2086. 10.1161/01.STR.31.9.2080.CrossRefPubMed
36.
37.
Colivicchi F, Bassi A, Santini M, Caltagirone C: Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke. 2004, 35: 2094-2098. 10.1161/01.STR.0000138452.81003.4c.CrossRefPubMed
38.
Barber M, Morton JJ, Macfarlane PW, Barlow N, Roditi G, Stott DJ: Elevated troponin levels are associated with sympathoadrenal activation in acute ischaemic stroke. Cerebrovasc Dis. 2007, 23: 260-266. 10.1159/000098325.CrossRefPubMed
39.
Kono T, Morita H, Kuroiwa T, Onaka H, Takatsuka H, Fujiwara A: Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium. J Am Coll Cardiol. 1994, 24: 636-640. 10.1016/0735-1097(94)90008-6.CrossRefPubMed
40.
Lee VH, Connolly HM, Fulgham JR, Manno EM, Brown RD, Wijdicks EFM: Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction. J Neurosurg. 2006, 105: 264-270. 10.3171/jns.2006.105.2.264.CrossRefPubMed
41.
Nef HM, Möllmann H, Akashi YJ, Hamm CW: Mechanisms of stress (Takotsubo) cardiomyopathy. Nat Rev Cardiol. 2010, 7: 187-193. 10.1038/nrcardio.2010.16.CrossRefPubMed
42.
Kelley WE, Januzzi JL, Christenson RH: Increases of cardiac troponin in conditions other than acute coronary syndrome and heart failure. Clin Chem. 2009, 55: 2098-2112. 10.1373/clinchem.2009.130799.CrossRefPubMed
43.
Song H, Back J, Jin D, Chung P, Moon H, Suh B, Kim Y, Kim BM, Woo HY, Lee YT, Park K: Cardiac troponin T elevation after stroke: relationships between elevated serum troponin T, stroke location, and prognosis. J Clin Neurol. 2008, 4: 75-83. 10.3988/jcn.2008.4.2.75.CrossRefPubMedPubMedCentral
44.
Thygesen K, Alpert JS, White HD: Universal definition of myocardial infarction. J Am Coll Cardiol. 2007, 50: 2173-2195. 10.1016/j.jacc.2007.09.011.CrossRefPubMed
Metadata
Title
Troponin elevation in acute ischemic stroke (TRELAS) - protocol of a prospective observational trial
Authors
Jan F Scheitz
Hans-Christian Mochmann
Christian H Nolte
Karl G Haeusler
Heinrich J Audebert
Peter U Heuschmann
Ulrich Laufs
Bernhard Witzenbichler
Heinz-Peter Schultheiss
Matthias Endres
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2011
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-11-98

Other articles of this Issue 1/2011

BMC Neurology 1/2011 Go to the issue

Research article

Mutations in WDR62 gene in Pakistani families with autosomal recessive primary microcephaly

Research article

Frequency of impulse control behaviours associated with dopaminergic therapy in restless legs syndrome

Case report

Anti-N-methyl-D-aspartate receptor encephalitis with serum anti-thyroid antibodies and IgM antibodies against Epstein-Barr virus viral capsid antigen: a case report and one year follow-up

Research article

Corticosteroid and antiviral therapy for Bell's palsy: A network meta-analysis

Research article

Decreased CD8+T cell response to Epstein-Barr virus infected B cells in multiple sclerosis is not due to decreased HLA class I expression on B cells or monocytes

Research article

Metabolic changes in concussed American football players during the acute and chronic post-injury phases