Stroke in right dorsal anterior insular cortex Is related to myocardial injury
Corresponding Author
Thomas Krause MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Address correspondence to Dr Thomas Krause, Center for Stroke Research Berlin, Department of Neurology, Charité–Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail: [email protected]Search for more papers by this authorKathrin Werner MD
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Search for more papers by this authorJochen B. Fiebach MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Search for more papers by this authorKersten Villringer MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Search for more papers by this authorSophie K. Piper PhD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Search for more papers by this authorKarl Georg Haeusler MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Search for more papers by this authorMatthias Endres MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
German Center for Cardiovascular Research (DZHK), Berlin, Germany
German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
Berlin Institute of Health (BIH), Berlin, Germany
Search for more papers by this authorJan F. Scheitz MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Search for more papers by this authorChristian H. Nolte MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Search for more papers by this authorCorresponding Author
Thomas Krause MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Address correspondence to Dr Thomas Krause, Center for Stroke Research Berlin, Department of Neurology, Charité–Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail: [email protected]Search for more papers by this authorKathrin Werner MD
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Search for more papers by this authorJochen B. Fiebach MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Search for more papers by this authorKersten Villringer MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Search for more papers by this authorSophie K. Piper PhD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Search for more papers by this authorKarl Georg Haeusler MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Search for more papers by this authorMatthias Endres MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
German Center for Cardiovascular Research (DZHK), Berlin, Germany
German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
Berlin Institute of Health (BIH), Berlin, Germany
Search for more papers by this authorJan F. Scheitz MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Search for more papers by this authorChristian H. Nolte MD
Charité–Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany
Charité–Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
Search for more papers by this authorAbstract
Objective
Elevated levels of cardiac troponin, and especially their relative changes over time, indicate acute myocardial injury. They are also frequently observed after acute ischemic stroke (AIS), indicating poor functional outcome and increased mortality. However, recent evidence showed that, in most AIS patients, myocardial injury is not caused by coronary ischemia. Instead, stroke lesion location has been suggested to precipitate myocardial injury.
Methods
Voxel-based lesion-symptom mapping (VLSM) was used in 299 patients who had a magnetic resonance imaging–confirmed acute ischemic stroke within the anterior circulation and a high-sensitivity cardiac troponin T (hs-cTnT) acquired on the day of admission. Of these, 228 had a second troponin measurement during the acute phase. The absolute hs-cTnT levels above the 99th percentile of a healthy reference population (≥14ng/l) as well as their relative temporal changes were used as continuous variables of interest in the VLSM model, including a multiple regression analysis adjusted for confounding variables.
Results
The anterior insular cortex of the right hemisphere, in particular its dorsal subregion, was significantly associated with the relative temporal changes of hs-cTnT (p < 0.01, corrected for multiple comparisons). In contrast, the baseline hs-cTnT levels on admission were not related to lesion location anywhere within the anterior circulation.
Interpretation
Our results amplify recent evidence from functional neuroimaging, which suggests a prominent role of dorsal anterior insular cortex in the parasympathetic control of cardiac and autonomic function. Acute vascular damage of this insular subregion might lead to autonomic dysbalance and an upregulation of sympathetic function, thereby resulting in myocardial injury. Ann Neurol 2017;81:502–511
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