Association of Cardiac Biomarkers in Combination With Cognitive Impairment After Acute Ischemic Stroke

Abstract

Background Poststroke cognitive impairment is a severe and common clinical complication that constitutes a substantial global health burden. We aimed to evaluate the association of 3 cardiac biomarkers in combination with poststroke cognitive impairment and their prognostic significance. Methods and Results This prospective study included 566 patients with ischemic stroke. Cardiac biomarkers, including sST2 (soluble suppression of tumorigenicity‐2 receptor), GDF‐15 (growth differentiation factor‐15), and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), were measured. Cognitive impairment was defined as a Mini‐Mental State Examination score of <27 or a Montreal Cognitive Assessment score of <25 at 3 months after ischemic stroke. Odds of cognitive impairment 3 months after ischemic stroke increased with the number of elevated cardiac biomarkers (sST2, GDF‐15, and NT‐proBNP; Ptrend<0.001). The multivariable adjusted odds ratios (95% CIs) of cognitive impairment defined by the Mini‐Mental State Examination and Montreal Cognitive Assessment were 2.45 (1.48–4.07) and 1.86 (1.10–3.14) for the participants with ≥2 elevated cardiac biomarkers, respectively, compared with those without any elevated cardiac biomarker. Additionally, higher cardiac biomarker scores were associated with an increased risk of cognitive impairment (Ptrend<0.05). Simultaneously adding all 3 cardiac biomarkers to the basic model with traditional risk factors significantly improved the risk prediction of Mini‐Mental State Examination‐defined cognitive impairment (net reclassification improvement=34.99%, P<0.001; integrated discrimination index=2.67%, P<0.001). Similar findings were observed using the Montreal Cognitive Assessment scores. Conclusions An increased number of elevated novel cardiac biomarkers were associated with an increased odds of poststroke cognitive impairment, suggesting that a combination of these cardiac biomarkers may improve the risk prediction of cognitive impairment. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.

Keywords

• cardiac biomarker
• cognitive impairment
• ischemic stroke
• MMSE
• MoCA