Abstract Body (Do not enter title and authors here): Introduction:
The association between elevated levels of high-sensitivity cardiac troponin I (cTnI) and clinical outcomes in stroke patients has been documented. Nevertheless, the precise significance of cTnI and its potential as a biomarker in ischemic stroke (IS) remains unclear. Our study sought to evaluate the correlation between serum cTnI levels and early neurological deterioration (END) in individuals experiencing stroke related to atrial fibrillation (AF).

Methods and Materials:
In this multicentric study, we enrolled consecutive patients with stroke related to atrial fibrillation (AF) from 2020 to 2023. Exclusion criteria for this study comprised large vessel stenosis/occlusion and previously identified etiologies upon admission. All patients underwent a comprehensive etiological assessment. Early neurological deterioration (END) was defined as a rise in the NIHSS score of at least 2 points from baseline to the 48-hour assessment.

Results:
A total of 1611 patients with stroke related to atrial fibrillation (AF) were assessed. In the multivariable analysis, cTnI (odds ratio [OR] = 1.32, 95% confidence interval [CI] 0.96–1.62; P < 0.005) remained statistically significant after controlling for confounding factors. The initial NIHSS score (OR = 0.98, 95% CI 0.92–1.11; P < 0.005) showed a positive association with early neurological deterioration (END), whereas the utilization of anticoagulants (OR = 0.61, 95% CI 0.51–0.74; P < 0.001) and new oral anticoagulants (OR = 0.71, 95% CI 0.37–1.36; P < 0.005), exhibited a negative association.

Conclusion:
Our study concluded that troponin elevation in patients with AIS may be attributed to the cumulative impact of comorbidities alongside neurological status, thereby highlighting the prognostic importance of troponin assessment.