Myocardial injury in transient global amnesia: a case‐control study

• Published in: European journal of neurology Vol. 26; no. 7; pp. 986 - 991
• Main Authors: Erdur, H., Siegerink, B., Ganeshan, R., Audebert, H. J., Endres, M., Nolte, C. H., Scheitz, J. F.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-07-2019
• Subjects: Amnesia; autonomic nervous system; Biomarkers; Blood pressure; Brain; brain–heart interaction; Calcium-binding protein; Cardiovascular diseases; Case reports; Confidence intervals; Headache; Health risk assessment; Health risks; Heart; Injuries; Migraine; Neuritis; neurogenic cardiomyopathy; Neurological diseases; Regression analysis; Risk analysis; Risk assessment; Risk factors; Statistical analysis; stress; transient global amnesia; Transient ischemic attack; Troponin; Troponin T; vestibular neuritis; Vestibular system; stress; autonomic nervous system; migraine; neurogenic cardiomyopathy; troponin; transient global amnesia; brain-heart interaction; vestibular neuritis
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.13920

Background and purpose
Elevation of cardiac troponin (cTn), a sensitive biomarker of myocardial injury, is frequently observed in severe acute neurological disorders. Case reports suggest that cardiac dysfunction may also occur in patients with transient global amnesia (TGA). Until now, no study has systematically assessed this phenomenon.
Methods
We performed a case‐control study using data of consecutive patients presenting with TGA from 2010 to 2015. Multiple logistic regression analysis accounting for age, sex and cardiovascular risk factors was performed to compare the likelihood of myocardial injury [defined as elevation of cTn > 99th percentile (≥14 ng/L); highly sensitive cardiac troponin T assay] in TGA with three reference groups: migraine with aura, vestibular neuritis and transient ischaemic attack (TIA).
Results
Cardiac troponin elevation occurred in 28 (25%) of 113 patients with TGA. Patients with TGA with cTn elevation were significantly older, more likely to be female and had higher blood pressure on admission compared with those without. The likelihood of myocardial injury following TGA was at least more than twofold higher compared with all three reference groups [adjusted odds ratio, 5.5; 95% confidence interval (CI), 1.2–26.4, compared with migraine with aura; adjusted odds ratio, 2.2; 95% CI, 1.2–4.4, compared with vestibular neuritis; adjusted odds ratio, 2.3; 95% CI, 1.3–4.2, compared with TIA].
Conclusions
One out of four patients with TGA had evidence of myocardial injury as assessed by highly sensitive cTn assays. The likelihood of myocardial injury associated with TGA was even higher than in TIA patients with a more pronounced cardiovascular risk profile. Our findings suggest the presence of a TGA‐related disturbance of brain–heart interaction that deserves further investigation.