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Troponinerhöhung nach ischämischem Schlaganfall

Troponin elevation in ischemic stroke patients

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Zusammenfassung

Kardio- und zerebrovaskuläre Erkrankungen sind die Hauptursachen für Tod und Behinderung im Erwachsenenalter weltweit. Zum einen ist der ischämische Schlaganfall eine häufige Komplikation bei Herzerkrankungen. Zum anderen führen kardiale Komplikationen nach akutem Schlaganfall häufig zu klinischen Verschlechterungen bis hin zum Tod. In der Notfallsituation werden bei Schlaganfallpatienten häufig auch kardiale Biomarker (vorzugsweise Troponin, cTn) bestimmt. Die Bestimmung von cTn wird in den Leitlinien zur Behandlung von Patienten mit akutem ischämischem Schlaganfall der American Heart Association (AHA) empfohlen. Pathologisch erhöhte Troponinwerte konfrontieren den klinisch tätigen Arzt dann mit der Frage nach den unmittelbaren diagnostischen und therapeutischen Konsequenzen. Bei Patienten mit akutem ischämischem Schlaganfall ist eine konkrete Handlungsempfehlung jedoch schwierig: Zum einen könnten neben einem akuten Koronarsyndrom auch andere Erkrankungen für die cTn-Erhöhung ursächlich sein. Zum anderen könnten klinische Zeichen eines akuten Koronarsyndroms durch die neurologischen Symptome des akuten Schlaganfalls verdeckt sein. Die Verbreitung der modernen hochempfindlichen cTn-Assays, die bereits den Nachweis von sehr geringen Mengen an zirkulierendem cTn ermöglichen, hat die Unsicherheit hinsichtlich der Bedeutung einer Troponinerhöhung bei Patienten mit ischämischem Schlaganfall noch verstärkt.

In diesem Übersichtsartikel werden mögliche Pathomechanismen beschrieben, die die häufige cTn-Erhöhung beim ischämischen Schlaganfall bedingen. Ferner werden Klinikern Interpretationshilfen und Handlungsempfehlungen vermittelt.

Abstract

Cerebrovascular and cardiovascular diseases are major causes of death and disability worldwide. Ischemic stroke is a frequent complication in cardiac diseases and, vice versa, cardiac complications commonly cause early clinical worsening and death after stroke. In the emergency setting, cardiac biomarkers (preferably troponin, cTn) are measured frequently in patients presenting with acute ischemic stroke. The measurement of cTn is recommended by the guidelines for early management of patients with acute ischemic stroke from the American Heart Association. In case of pathologic cTn elevation, physicians are confronted with diagnostic and therapeutic uncertainties. Up-to-date recommendations on interpretation and consecutive actions remain ambiguous because cTn elevations may originate from causes other than acute coronary disease and because clinical signs and symptoms of acute coronary disease may be obscured by neurological deficits of the stroke. The application of modern, high-sensitive cTn assays that detect even minor cTn elevations has rather aggravated the dilemma of how to interpret this finding in patients with ischemic stroke.

This article gives an overview on possible mechanisms of the frequently observed cTn elevation in ischemic stroke patients and offers help on interpretation and meaningful actions.

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Authors and Affiliations

  1. Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    C.H. Nolte, J.F. Scheitz Dr. & M. Endres Prof. Dr.

  2. Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    C.H. Nolte, J.F. Scheitz Dr. & M. Endres Prof. Dr.

  3. Excellence Cluster NeuroCure, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    M. Endres Prof. Dr.

  4. Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Deutschland

    M. Endres Prof. Dr.

  5. Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland

    M. Endres Prof. Dr.

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Interessenkonflikt

C.H. Nolte hat Vortragshonorare von Bayer, Boehringer Ingelheim, Pfizer und Bristol-Myers Squibb erhalten. J.F. Scheitz ist Stipendiant des Clinical Scientist Programms. M. Endres hat Zuwendungen für Projekte, Advisory Boards bzw. Vortragshonorare von folgenden Firmen erhalten: Bayer HealthCare, Boston Scientific, Bristol-Myers Squibb, Boehringer-Ingelheim, Pfizer. Die Autoren besitzen keine Aktien von Pharmaunternehmen oder Herstellern von Laborgeräten.

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M. Buerke, Siegen

Dieser Beitrag ist eine gekürzte und modifizierte Fassung der englischsprachigen Übersichtsarbeit der Autoren [38].

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Nolte, C., Scheitz, J. & Endres, M. Troponinerhöhung nach ischämischem Schlaganfall. Med Klin Intensivmed Notfmed 112, 222–226 (2017). https://doi.org/10.1007/s00063-015-0116-x

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  • DOI: https://doi.org/10.1007/s00063-015-0116-x

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