Examination Of Troponin Levels and Electrocardiographic Changes in Patients with Acute İschemic Stroke

Year 2020, Volume: 7 Issue: 2, 65 - 69, 31.08.2020

Sinan Yıldırım , Mehmet Tayfun Kaşıkcı

Abstract

Stroke ranks second among the causes of death in the world and is mostly for ischemic reasons. In patients with acute ischemic stroke, cardiac troponins may increase without primary cardiac damage. It is known that different ECG findings such as atrial fibrillation (AF), QT prolongation and AV blocks and life-threatening ventricular arrhythmias can be seen in stroke patients. P wave dispersion (Pdis) is significantly higher in patients with idiopathic paroxysmal atrial fibrillation. QTC prolongation and QT dispersion (QTdis) have been reported in patients with acute ischemic stroke. In our study, we examined the role of cardiac markers and ECG findings in acute ischemic stroke disease by comparing patients' laboratory findings and demographic data with the control group. Hospital automation system and patient files were used to obtain patient information over the past 1 year period. Patients with acute ischemic stroke diagnosis above 18 years of age, diagnosed with neurological examination and imaging tests, without of known history of ischemic heart disease, rhythm disorders, structural heart diseases, previous stroke history, hypertension, diabetes mellitus, anemia, chronic liver disease, chronic kidney failure, hypo-hypertrophy, and rheumatic disease were included in the study. 110 cases without acute ischemic stroke and with the same criteria as the patient group were included as the control group. ECG, white blood cell, glucose, urea, creatinine, sodium, potassium, calcium and cardiac troponin T (hs-cTnT) values of the cases were examined. The hs-cTnT values, P dispersion, QT dispersion and QTc dispersion measurements of the acute ischemic stroke patients were statistically significantly higher than those of the control group (p <0.001). It was determined that Hs-cTnT value had significance independently from other parameters (p = 0.001). We concluded that increased hs-cTnT value is a more valuable marker than Pdis, QTdis and QTc dispersion in patients admitted to the hospital with acute ischemic stroke.

Keywords

Acute ischemic stroke, High sensitive troponin, P dispersion, QT-QTc dispersion

Akut İskemik İnmeli Olgularda Troponin Düzeyleri ve Elektrokardiyografik Değişikliklerin İncelenmesi

Abstract

İnme Dünya’da ölüm nedenleri arasında ikinci sırada yer almakta olup çoğunlukla iskemik nedenlidir. Akut iskemik inmeli hastalarda kardiyak troponinler primer kardiyak hasar olmaksızın yükselebilir. İnme hastalarında atrial fibrilasyon (AF), QT uzaması ve AV blokları ile hayatı tehdit eden ventriküler aritmiler gibi farklı EKG bulgularının görülebileceği bilinmektedir. P dalga dispersiyonu (Pdis) idiyopatik paroksismal atrial fibrilasyonlu hastalarda belirgin olarak daha yüksektir. Akut iskemik inmeli hastalarda QTC uzaması ve QT dispersiyonunun (QTdis) görülebildiği bildirilmiştir. Çalışmamızda kardiyak belirteçlerin ve EKG bulgularının akut iskemik inme hastalığındaki rolünü hastaların laboratuvar bulguları ve demografik verilerini kontrol grubu ile karşılaştırarak inceledik. Hasta bilgilerinin elde edilmesinde geçmiş 1 yıllık zaman aralığında hastane otomasyon sistemi ve hasta dosyaları kullanıldı. 18 yaş üstü akut iskemik inme tanısı nörolik muayene ve görüntüleme tetkikleri ile konulmuş, özgeçmişinde bilinen iskemik kalp hastalığı, ritim bozuklukları, yapısal kalp hastalıkları, eski inme öyküsü, hipertansiyon, diyabetes mellitus, anemi, kronik karaciğer hastalığı, kronik böbrek yetmezliği, hipo-hipertroidi, romatizmal hastalık olmayan 97 hasta çalışmaya dahil edildi. Akut iskemik inmesi olmayan ve hasta grubu ile aynı kriterlere sahip 110 olgu kontrol grubu olarak alındı. Olguların EKG, beyaz küre, glukoz, üre, kreatinin, sodyum, potasyum, kalsiyum ve kardiyak troponin T (hs-cTnT) değerleri incelendi. Akut iskemik inme hastalarının hs-cTnT değerleri, P dispersiyonu, QT dispersiyonu ve QTc dispersiyonu ölçümleri kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu (p<0.001). Hs-cTnT değerinin diğer parametrelerden bağımsız olarak anlamlılık kazandığı görüldü (p=0.001). Akut iskemik inme ile hastaneye başvuran hastalarda hs-cTnT yüksekliğinin, Pdis, QTdis ve QTc dispersiyonundan daha değerli bir belirteç olduğu sonucuna vardık.

Keywords

Akut iskemik inme, High sensitive troponin, P dispersiyonu, QT-QTc dispersiyonu

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