J Neurocrit Care.  2018 Jun;11(1):23-31. 10.18700/jnc.170036.

Cardiovascular Biomarkers during Acute Periods of Ischemic Stroke due to Non-Valvular Atrial Fibrillation

• Kim T
• Koo J
• Song IU
• Han SR
• Chung SW
• Kim SH
• Lee KS

• KMID: 2426210
• DOI: http://doi.org/10.18700/jnc.170036

Abstract

BACKGROUND
A subanalysis study of the ENGAGE AF-TIMI 48 trial showed that cardiac troponin I, N-terminal proB-type natriuretic peptide, and D-dimer, were powerful predictors of cerebrovascular adverse events. We aimed to evaluate D-dimer and cardiac troponin I levels during the acute period of ischemic stroke in anticoagulation-naïve patients with non-valvular atrial fibrillation (NVAF) and also studied the association between these biomarkers and stroke severity.
METHODS
Consecutive anticoagulation-naïve patients with acute ischemic stroke due to NVAF were enrolled within two days after each stroke event, and all patients were stratified into either moderate-to-severe or mild neurologic deficit groups using the National Institutes of Health Stroke Scale (NIHSS) at admission.
RESULTS
A total of 98 patients were enrolled in this study. The median value for the D-dimer was above the upper limit of the normal reference range, but the troponin I value was within the normal range for all patients. After adjusting for CHA2DS2-VASc risk factors, the log-transformed values for D-dimer were positively correlated with an increasing NIHSS score (r=0.233; P=0.051). In the multivariate logistic analysis, the log-transformed D-dimer was positively associated with more severe strokes (odds ratio, 30.1; 95% confidence interval [CI], 1.9-486.2 and 29.7; 95% CI, 2.0-430.8 in the upper two quartiles respectively). The log-transformed values for troponin I did not correlate with the NIHSS score.
CONCLUSION
D-dimer levels were higher and an independent risk factor for severe stroke in anticoagulation-naïve patients with NVAF related stroke. In contrast, troponin I levels were normal and were not associated with stroke severity.

Keyword

Biomarkers; Stroke; Atrial fibrillation

MeSH Terms

Atrial Fibrillation*
Biomarkers*
Humans
National Institutes of Health (U.S.)
Neurologic Manifestations
Reference Values
Risk Factors
Stroke*
Troponin I
Biomarkers
Troponin I

Figure

• 

  Figure 1. Box plots for D-dimer (A) and troponin I (B) levels. The horizontal line inside each box indicates the median, the top and bottom of the box indicate the interquartile range, the I bars indicate the 5th and 95th percentiles, and circles indicate outliers.

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  Figure 2. Flow diagram for recruitment. AF, atrial fibrillation; NVAF, non-valvular atrial fibrillation.

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  Figure 3. Scatterplot graph with a regression line between the log-transformed values of D-dimer and NIHSS at admission (A), and between the log-transformed values of troponin I and NIHSS at admission (B). Analyses were performed using partial correlation coefficient analysis adjusted for CHA2DS2-VASc risk factors.

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