Wolfram Doehner

High-sensitivity cardiac troponin T and severity of cerebral white matter lesions in patients with acute ischemic stroke

IntroductionCardiac troponin (hs-cTnT) is a sensitive marker of myocardial injury and has been linked to incident dementia. The underlying mechanism of that observation is still unknown. Given that severity of cerebral small vessel disease is a predictor of cognitive decline, we aimed to explore whether there is an association between hs-cTnT and severity of white matter lesions (WML) as a marker of cerebral small vessel disease in patients with ischemic stroke.MethodsWe analyzed consecutive acute ischemic stroke patients admitted to Charité-University Hospital, Berlin from 2011 to 2013. Severity of WML was graded on 3T-MRI using the age-related white matter severity score (ARWMS). Patients with hs-cTnT elevation suggestive of acute coronary syndrome (ACS) were excluded (hs-cTnTu2009>u200952xa0ng/l or dynamic change of hs-cTnTu2009>u200950%, ESC guideline). We performed unadjusted and adjusted quantile regression models to assess the association between increased hs-cTnT (dichotomized at the 99th percentile, 14xa0ng/l) and severity of WML.ResultsA total of 860 patients was analyzed (median age 73xa0years, 44.8% female, median ARWMS 6). Patients with elevated hs-cTnT had more extensive WML than those without (median ARWMS 8 vs. 5, adjusted beta for 50th percentile 1.12, 95% CI 0.41–1.84). The association between WML and hs-cTnT elevation was strongest in patients with severe WML (adjusted beta 1.77, 95% CI 0.26–3.27 for 80th WML percentile).ConclusionElevated hs-cTnT levels were associated with extent of WML in acute stroke patients. Further studies are needed to assess whether hs-cTnT can be used to identify stroke patients at risk for cognitive decline.

Estimating fat mass in heart failure patients

Introduction Body composition (BC) assessments in heart failure (HF) patients are mainly based on body weight, body mass index and waist-to-hip ratio. The present study compares BC assessments by basic anthropometry, dual energy X-ray absorptiometry (DXA), bioelectrical impedance spectroscopy (BIS), and air displacement plethysmography (ADP) for the estimation of fat (FM) and fat-free mass (FFM) in a HF population. Material and methods In this single-centre, observational pilot study we enrolled 52 patients with HF (33 HF with reduced ejection fraction (HFrEF), 19 HF with preserved ejection fraction (HFpEF); mean age was 67.7 ±9.9 years, 41 male) and 20 healthy controls. DXA was used as a reference standard for the measurement of FM and FFM. Results In the HF population, linear regression for DXA-FM and waist-to-hip ratio (r = –0.05, 95% CI: (–0.32)–0.23), body mass index (r = 0.47, 95% CI: 0.23–0.669), and body density (r = –0.87, 95% CI: (–0.93)–(–0.87)) was obtained. In HF, Lin’s concordance correlation coefficient of DXA-FM (%) with ADP-FM (%) was 0.76 (95% CI: 0.64–0.85) and DXA-FFM [kg] with DXA-ADP [kg] was 0.93 (95% CI: 0.88–0.96). DXA-FM (%) for BIS-FM (%) was 0.69 (95% CI: 0.54–0.80) and 0.73 (95% CI: 0.60–0.82) for DXA-FFM [kg] and BIS-FFM [kg]. Conclusions Body density is a useful surrogate for FM. ADP was found suitable for estimating FM (%) and FFM [kg] in HF patients. BIS showed acceptable results for the estimation of FM (%) in HFrEF and for FFM [kg] in HFpEF patients. We encourage selecting a suitable method for BC assessment according to the compartment of interest in the HF population.