Abstract

Elevation of serum cardiac troponin is a specific marker of the acute coronary syndrome. Serum troponin titer can be elevated in patients with acute ischemic stroke, but its clinical implications remain unclear. Several mechanisms can result in elevated serum troponin levels during the early phase of ischemic strokes, such as primary myocardial injury with secondary cardioembolic cerebral ischemia or primary cerebral ischemia with secondary myocardial damage attributable to activation of the sympathoadrenal system. CK-MB is an enzyme found primarily in the heart muscle but also in the tongue, diaphragm, uterus, prostate, and skeletal muscle. It is considered an important marker for acute myocardial infarction, but it has not been thoroughly studied in stroke. The literature shows insufficient data regarding the association and prediction of morbidity and mortality following acute ischemic stroke and serum cardiac markers. This study aims to measure serum troponin and CK-MB levels in patients with acute stroke and their relation to stroke severity and hospital mortality. An eleven-month cross-sectional study on 100 patients was done in Basrah Teaching Hospital from February to December 2018, involving acute ischemic stroke patients in the neurological and medical wards who presented within 24 hours. Serum troponin and CK-MB titers were measured; a brain CT scan was done to diagnose ischemic stroke. Out of 100 patients, 14 (14%) had a positive troponin titer, 29 (29%) had a positive CK-MB, and ten (10%) had a severe stroke based on their NIHSS score at admission. Those with severe stroke were (60%) and (70%) positive for troponin titers and CK-MB, respectively, with a mortality rate of 40%. The study concludes that serum troponin titer and CK-MB are significantly associated with the severity and mortality of acute ischemic stroke.