Multiple Cardiac Biomarkers and Long‐Term Neurological Deficits Trajectory After Ischemic Stroke

Background The dynamic changes of neurological function frequently occur after ischemic stroke, while the underlying mechanisms remain unclear. Given cardiac pathologies from heart‐brain axis may contribute to neurological decline, we aimed to investigate associations between cardiac biomarkers and long‐term neurological deficits (ND) trajectory after ischemic stroke. Methods We derived data from China Antihypertensive Trial in Acute Ischemic Stroke, circulating NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), sST2 (soluble ST2), and GDF‐15 (growth differentiation factor 15) concentrations were measured. We applied group‐based trajectory modeling to identify ND trajectories using National Institutes of Health Stroke Scale scores measured at admission, 14 days/hospital discharge, and 3‐month, 12‐month, and 24‐month follow‐up visits. Results We identified 3 ND trajectories: mild, moderate, and persistent‐severe. Compared with the lowest tertile, the odds ratios for the highest tertiles of NT‐proBNP, sST2, and GDF‐15 for persistent‐severe ND trajectory were 2.20 (95% CI, 1.61–2.99), 3.52 (95% CI, 2.58–4.82), and 2.09 (95% CI, 1.54–2.84), respectively. Patients with ≥2 elevated biomarkers had higher risks of moderate ND and persistent‐severe ND trajectories (both P <0.05). Because National Institutes of Health Stroke Scale scores of moderate and mild ND trajectories remained <5 after discharge, when we merged them into a “minor stroke” group, NT‐proBNP, sST2, and GDF‐15 were still associated with persistent‐severe stroke (versus minor stroke). Simultaneously adding 3 biomarkers to the conventional factors model provided significant incremental value for the risk stratification of persistent‐severe stroke (net reclassification improvement ranging from 40.5% to 58.1%, all P <0.05). Conclusions Cardiac biomarkers were associated with long‐term moderate ND and persistent‐severe ND trajectories after ischemic stroke.