BACKGROUND Elevated high-sensitive cardiac troponin (hs-cTn) can be found in more than 50% of the patients with acute ischemic stroke. The observational TRoponin ELevation in Acute ischemic Stroke (TRELAS) study revealed that about 25% of all stroke patients with elevated troponin had a coronary angiography-detected culprit lesion affording immediate intervention, and about 50% of all patients did not have any obstructive coronary artery disease. Given the risk of procedure-related complications, the identification of stroke patients in urgent need of invasive coronary angiography is desirable. METHODS TRELAS patients were prospectively enrolled into this sub-study. In addition to conventional coronary angiography, a cardiac magnetic resonance imaging (MRI) at 3T was performed during the in-hospital stay after acute ischemic stroke to compare the diagnostic value of both imaging modalities. RESULTS Nine stroke patients (median age 73 years [range 58-87]; four females; median NIH Stroke Severity score on admission 4 [range 0-6] with elevated hs-cTnT [median 74 ng/L, interquartile range 41-247] on admission) completed cardiac MRI and underwent coronary angiography. The absence of MRI-detected wall motion abnormalities and/or late gadolinium enhancement in 5 stroke patients corresponded with the exclusion of culprit lesions or significant coronary artery disease by coronary angiography. Four patients had abnormal MRI findings, whereof 2 showed evidence of myocardial infarction and in whom coronary angiography demonstrated a >70% stenosis of a coronary artery. CONCLUSIONS The TRELAS sub-study indicates that noninvasive cardiac MRI may provide helpful information to identify stroke patients with or without acute coronary syndrome. Our findings might help to select stroke patients in urgent need of coronary angiography.

中文翻译：

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急性缺血性卒中和肌钙蛋白升高的患者的心脏磁共振成像：急性缺血性卒中（TRELAS）亚型中的钙蛋白升高。

背景技术在50％以上的急性缺血性卒中患者中，发现高敏感性心肌肌钙蛋白（hs-cTn）升高。急性缺血性卒中中观察到的TROPonin升高（TRELAS）研究显示，在所有肌钙蛋白升高的卒中患者中，约有25％的冠状动脉造影检测到的罪犯病变需要立即干预，而所有患者中约50％的患者没有阻塞性冠状动脉疾病。考虑到与手术相关的并发症的风险，急需确定有创冠状动脉造影的卒中患者。方法前瞻性地将TRELAS患者纳入该子研究。除了传统的冠状动脉造影术，在急性缺血性中风后住院期间，在3T时进行了心脏磁共振成像（MRI），以比较两种成像方式的诊断价值。结果9名中风患者（中位年龄73岁[范围58-87]；四名女性；入院时NIH中风严重度评分中位数4 [范围0-6]，hs-cTnT升高[中位数74 ng / L，四分位间距41-247]入院）完成心脏MRI并进行冠状动脉造影。在5例卒中患者中，没有MRI检测到的壁运动异常和/或晚期late增强，这与通过冠状动脉造影排除了罪魁祸首或明显的冠状动脉疾病相对应。4例MRI表现异常，其中2例显示出心肌梗塞的证据，并且冠状动脉造影显示> 冠状动脉狭窄70％。结论TRELAS子研究表明，非侵入性心脏MRI可能为识别患有或不患有急性冠状动脉综合征的中风患者提供有用的信息。我们的发现可能有助于选择急需冠状动脉造影的中风患者。