When the Brain Speaks to the Heart: Unveiling Elec-trocardiographic and Cardiac Troponin T Changes Across Age Groups in Acute Ischemic Stroke

Background/Objectives: Electrocardiographic (ECG) abnormalities are common in acute ischemic stroke and may reflect cardiac involvement associated with cerebrovascular injury. This study aimed to assess the prevalence and patterns of ECG abnormalities and compare their occurrence between patients of working age (18–65 years) and older patients (66–75 years), with particular attention to cardiac rhythm, repolarization abnormalities, and cardiac troponin T (TnT) levels. Methods: This one-year prospective study included 230 patients with first acute ischemic stroke admitted to the Clinic for Neurology, University Clinical Center Tuzla, Bosnia and Herzegovina. Standard 12-lead ECG and TnT levels were assessed on the first day of admission. ECG findings and TnT levels were compared between the two age groups, and their association with clinical outcome was evaluated using modified Rankin scale (mRS). Results: The study included 103 working-age patients and 127 older patients. The most frequent ECG abnormalities were T-wave inversion (47.8%), ST-segment depression (37.8%), bundle branch blocks (35.7%), and atrial fibrillation (19.1%). Sinus rhythm was significantly more frequent among working-age patients than older patients (90.3% vs. 74.0%; χ²=9.91; p=0.002), whereas atrial fibrillation was more prevalent in older patients (26.8% vs. 9.7%; χ²=10.70; p=0.001). T-wave inversion was also more frequent among older patients (54.3% vs. 39.8%; χ²=4.82; p=0.028). ST-segment depression showed the greatest difference between groups (49.6% vs. 23.3%; χ²=16.73; p<0.001; Cramer's V=0.270). TnT levels differed significantly between groups (U=9097.00; p<0.001), with higher mean ranks in older patients. Elevated TnT levels were associated with unfavorable clinical outcomes in the older group. Conclusions: Age-related differences were observed in ECG abnormalities and TnT levels in acute ischaemic stroke. Atrial fibrillation, T-wave inversion, ST-segment depression, and higher TnT levels were more prominent among older patients. Elevated TnT may have prognostic relevance in older patients with acute ischaemic stroke.