# Myocardial injury in patients with acute ischemic stroke: Prevalence and types of triggers of myocardial demand ischemia

## TL;DR

About 25% of patients with acute ischemic stroke experience myocardial injury, often due to an imbalance between oxygen supply and demand, with specific triggers like respiratory failure and hypertension being common.

## Contribution

This study identifies and quantifies triggers of myocardial demand ischemia in stroke patients, revealing their strong association with acute myocardial injury.

## Key findings

- Predefined triggers of demand ischemia were present in 42% of patients with acute myocardial injury compared to 24% in controls.
- The most common triggers included respiratory failure, sustained hypertension, tachyarrhythmia, and hemodynamic shock.
- Stroke severity and insular cortex involvement were associated with trigger presence.

## Abstract

Acute myocardial injury occurs in about every fourth patient in the early phase after ischemic stroke. It may be caused by an imbalance between myocardial oxygen supply and demand, potentially leading to type 2 myocardial infarction (MI). However, little is known about the prevalence of potential triggers of such demand ischemia in acute stroke.

Consecutive patients with and without post-stroke acute myocardial injury (elevated high-sensitivity cardiac troponin T [hs-cTnT] levels with a rise/fall >20%) were matched for age and sex and retrospectively screened for presence of predefined triggering conditions of myocardial demand ischemia and fulfillment of diagnostic criteria for acute MI.

Among 508 stroke patients analyzed (median age 81 [73–86] years, 52% female), predefined potential triggers of demand ischemia were present in 107/254 (42%) patients with acute myocardial injury and in 61/254 (24%) matched controls (adjusted OR 2.30, 95%CI 1.51–3.52, p < 0.001). Patients with a trigger were older, more often female, had more severe strokes, and more often insular cortex involvement. The most prevalent triggers were respiratory failure, sustained hypertension, supraventricular tachyarrhythmia, and hemodynamic shock. MI criteria were fulfilled in 44/254 (17%) patients with acute myocardial injury including 27/44 (61.4%) with a trigger of demand ischemia (i.e. suspected type 2 MI).

Conditions triggering a myocardial oxygen demand/supply mismatch are highly prevalent in patients with acute myocardial injury detected after stroke, notably in those fulfilling the criteria of acute MI. Stroke-specific aspects such as stroke severity or lesion location may play a role in the development of such triggers.

Graphical abstract