Identification of Risk Factors for Myocardial Injury in Acute Ischemic Stroke with Diabetes Mellitus: A Retrospective Cohort Study on Stroke-Heart syndrome

Huijuan Pu¹Yumin Wang²Guoping Zhao¹Bingbing Shi¹Ni An³Changxi Zhang²Jie Liu²Wanling Wu²Hong Zhu²Lei Li¹Defeng Pan^2*

• ¹Department of General Practice, Xuzhou Medical University, Xuzhou, China
• ²Department of Cardiology, Xuzhou Medical University, Xuzhou, China
• ³Department of Geriatric Medicine, Xuzhou Medical University, Xuzhou, China

Ischemic stroke (IS) causes significant death and disability. Stroke-Heart Syndrome (SHS) involves cardiovascular complications, worsening outcomes. Diabetes mellitus (DM) increases the risk of myocardial injury following IS. This study explores risk factors for myocardial injury in acute ischemic stroke ( AIS) with DM patients to improve early identification and prevention.This is a retrospective cohort study. Inclusion criteria: neuroimaging-confirmed AIS, admission within hours, and measured cardiac troponinT (cTnT) levels. Exclusion criteria included acute hemorrhagic stroke, other cTnT elevation causes, severe organ failure, infections, malignancies, and missing data.Logistic and LASSO regression analyses identified independent risk factors for myocardial injury.Myocardial injury occurred in 194 patients. Independent risk factors identified were coronary heart disease (CHD), insular cortex lesions, peak brain natriuretic peptide precursor(peak NT-proBNP), C-reactive protein (CRP), and higher National Institutes of Health Stroke Scale (NIHSS) scores.These factors were significantly associated with myocardial injury and ROC analysis showed that the AUC for CHD was 0.621, the AUC for insular cortex lesions was 0.648, the AUC for NIHSS score was 0.726, the AUC for peak NT-proBNP was 0.816 and the AUC for CRP was 0.764. Subgroup analysis suggested that reperfusion therapy was associated with increased myocardial injury risk in various patient subgroups. CHD, insular cortex lesions, peak NT-proBNP and CRP levels, and higher stroke severity (NIHSS score) are significant risk factors for myocardial injury in AIS patients with DM.Stroke, is a disease caused by acute disorder of cerebral blood circulation and the third leading cause of death worldwide 1,2 . It is estimated that by 2030, approximately 22 million people will die or suffer from disability due to stroke 2,3 . Among the different types of stroke, of which ischemic stroke (IS) is the most prevalent of type, accounting for approximately 65.3% stroke 2 .Recent studies have highlighted a close relationship between the central nervous system and the cardiovascular system. Stroke not only directly impacts brain function but also exerts profound effects on the heart through neuroendocrine pathways, a phenomenon known as Stroke-Heart Syndrome (SHS) 4 . The SHS can be classified into 5 main categories: 1) ischemic and nonischemic