Purpose Elevated troponin is frequent in acute ischaemic stroke but its clinical implication remain unclear. The aim of this study is to describe prevalence, predictive factors and prognosis of patients with troponin elevation in acute ischaemic stroke. A second end point was to diagnose a potential ischaemic heart disease with cardiac magnetic resonance imaging (MRI) performed in ten days after stroke. Methods 146 consecutive patients admitted for acute ischaemic stroke in our stroke unit were prospectively enrolled between july and november 2009. The blood troponin Ic was measured in the first two days after admission. Clinical and biological data, stroke severity attested by national institute of health stroke scale (NHISS) and in-hospital mortality were compared between the two groups with and without troponin elevation. A cardiac MRI was performed during hospitalization if troponin was positive. Results Serum troponin was elevated in 23 patients (15,7%). After multivariate analysis, 6 independent factors were associated with troponin elevation: diabetes, 2 or more prior cardiovascular events, thrombolysis, multiple localization of stroke, SGOT elevation and creatinin >120 μmol/L. Moreover, the 3 factors associated with in-hospital mortality after logistic regression were troponin elevation (OR = 2,56 [1,11+6,02] p = 0,031), prior myocardial infarction (OR = 2,94 [1,16–7,95] p = 0,002) and severe NIHSS at admission (OR = 3,07 [1,35–7,39] p = 0,007) Only 2 cardiac MRI have been readable because other patients were died before the exam or were unable to have this exam because of stroke severity, confusion or rapid atrial fibrillation. One of these patients had an acute myocardial infarction diagnosed by cardiac MRI but a normal coronarography. Conclusion Elevated troponin in acute ischaemic stroke is an independent factor of in-hospital mortality. A troponin rise is more frequent in patients with diabetes or prior cardiovascular events that's why a screening of ischaemic heart disease should be performed. Cardiac MRI can’t be widely performed at the early stage of stroke, however it has been decisive for one patient in this study.