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DOI: 10.1055/s-0037-1616354
Interpretation von erhöhtem Troponin bei Patienten mit ischämischem Schlaganfall
Interpretation of elevated cardiac troponins in patients with ischaemic strokePublikationsverlauf
eingegangen am:
21. September 2015
angenommen am:
23. September 2015
Publikationsdatum:
10. Januar 2018 (online)
Zusammenfassung
Kardiales Troponin (cTn) ist aufgrund der hohen Sensitivität und Spezifität für Myokardschädigungen obligater Bestandteil bei der Diagnosestellung eines akuten Myokardinfarktes. Allerdings zeigt ein erhöhtes cTn nicht die Entstehungsmechanismen der Myokardschädigung an. Bereits seit vielen Jahrzehnten ist bekannt, dass es im Rahmen akuter zerebrovaskulärer Ereignisse häufig zu kardialen Komplikationen wie Arrhythmien, kardialer Dysfunktion, autonomer Imbalance, EKG-Veränderungen und zum Anstieg kardialer Biomarker kommen kann. Dies kann im Einzelfall große differenzialdiagnostische Probleme bereiten. Die weite Verbreitung hochsensitiver cTn-Assays, die sehr geringe Mengen cTn nachweisen können, hat diese Situation weiter verschärft. Ziel dieses Übersichtsartikels ist es, die Literatur hinsichtlich Häufigkeit und prognostischer Bedeutung von cTn-Erhöhungen nach Schlaganfall zusammenzufassen, Entstehungsmechanismen von cTn-Erhöhungen nach Schlaganfall zu erläutern und dem Kliniker Hinweise für die Interpretation und den Umgang mit pathologischen cTn-Werten zu geben.
Summary
Cardiac troponin (cTn) is the biomarker of choice for diagnosis of myocardial infarction. Although cTn is a highly specific biomarker for myocardial injury, it does not reveal the underlying pathomechanism. It has long been recognized that acute cerebrovascular events are often accompanied by cardiac dysfunction, autonomic imbalance, ECG alterations and elevation of cardiac bio-markers. Thus, interpretation of elevated cTn may be challenging in the individual patient. Uncertainties further increased with the wide-spread use of high-sensitivity cTn assays, which enable detection of minute amounts of myocardial injury. In this narrative review, we aim to summarize data on frequency and prognostic relevance of cTn elevation in acute ischaemic stroke, describe underlying causes of cTn elevation, and provide clinicians with tools for interpretation and reasonable application of cTn.
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