A prospective observational study on electrocardiogram and troponin t changes in stroke

Background: The mechanisms explaining morphological electrocardiogram (ECG) changes and increased troponin T (TnT) in acute stroke are unclear. The aims of the present study were to assessthe prevalence of ECG and TnT changes in acuteischemic stroke, to investigate whether ischemiclike ECG changes correlate to a rise in TnT and to examine whether ECG changes and elevated TnT predict a poor short-time outcome.
Methods: From 2015 to 2017 over a period of two years a Prospective observational study on total of 200 patients suffering from acute ischemic stroke were included prospectively in the present study. ECG and TnT was carried out and analyzed at admission in all patients. MRS was compared on admission day and 90th day with NIHS and Tnt. The troponin T values was correlated to prognosis after the evaluation of modified Rankin scale.Regression Statistics and Annova was performed and data was statistically analyzed at end of the study using SPSS ver. 21
Results: In total of 200 patients 0.5% subjects were from 0-30 yrs. of age. 45% from 31-60 yrs., majority 52.5% from 61-90 yr. and 2% above 90 yrs. 61% were male and 39% were female. Systemic illness included 78% hypertensive subjects, 89.5% diabetes mellitus, 27% had lacunar and 73/5 had large vessel stroke. NIHS had a significant value of 0.024 as 43.5 & had bad prognosis and 56.5 had good prognosis. According to Troponin T level 43.5% had bad prognosis and 56.5% had a good prognosis. 2% had Left ACA+Right ACA, majority of 74.5 % had Left MCA+Right MCA, 1.5% had Left MCA+ACA & Right MCA+ACA 20.5% had Left PCA+Right PCA and 1.5% had Right MCA+PCA watershed. 43.5% had Normal Troponin, 38% had Borderline Troponin, and 18.5% had High Troponin. Aspect was 54.50% for 6-7, 44% for 8-9, 1.5% for more than 9. In Electrocardiogram 1% had AF, left ventricular hypertrophy, 0.5% had Deep Q wave in inferior, 1% had Hyperacute waves, 5% had Left ventricular hypertrophy, 0.5% had LBBB, majority of 58.5% were normal, 2% had prolonged QT, 6% had RBBB, 22% had ST depression, T wave inversion, 0.5% had ST elevation, 0.5% had ST upsloping septal leads, 2.5 % had T wave inversion, 0.5% had U wave. MRS day 1 v/s NIHS and MRS day 90 v/s NIHS were significant in ANOVA and also MRS day 1 v/s Trop T and MRS day 90 v/s Trop T had significant value.
Conclusion: ECG changes are prevalent in acute ischemic stroke. ST depression and Q waves are related to an increase in TnT, suggesting that these ECG changes may indicate coexisting ischemic heart disease. A rise in TnT predicts a poor outcome. Patients with acute ischemic stroke should be offered adequate treatment with secondary prevention and preferably a follow-up with focus on cardiologic as well as neurological aspects.