Cardiovascular Predictors of In-Patient Mortality After Subarachnoid Hemorrhage
Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States Neurocritical Care
(Impact Factor: 2.44).
02/2006; 5(2):102-7. DOI: 10.1385/NCC:5:2:102
Whether cardiac dysfunction contributes to morbidity and mortality after subarachnoid hemorrhage (SAH) remains controversial. The objective of this study was to test the hypothesis that cardiovascular abnormalities are independently related to in-patient mortality after SAH.
This was a prospective cohort study of patients with aneurysmal SAH. Heart rate and blood pressure were measured, a blood sample was obtained, and echocardiography was performed on three study days, starting as soon after admission as possible. The cardiovascular predictor variables were heart rate, systolic blood pressure (SBP), cardiac troponin I (cTi) level, B-type natriuretic peptide (BNP) level, and left ventricular ejection fraction. The primary outcome measure was in-patient mortality. The association between each predictor variable and mortality was quantified by multivariate logistic regression, including relevant covariates and reporting odds ratios (OR) and 95% confidence intervals (CI).
The study included 300 patients. An initial BNP level greater than 600 pg/mL was markedly associated with death (OR 37.7, p < 0.001). On the third study day (9.1 +/- 4.1 days after SAH symptom onset), a cTi level greater than 0.3 mg/L (OR 7.6, p = 0.002), a heart rate of 100 bpm or greater (OR 4.9, p = 0.009), and a SBP less than 130 mmHg (OR 6.7, p = 0.007) were significantly associated with death.
Cardiovascular abnormalities are independent predictors of in-patient mortality after SAH. Though these effects may be explained by a reduction in cerebral perfusion pressure or other mechanisms, further research is required to determine whether or not they are causal in nature.
Available from: PubMed Central
- "In a study involving 14 patients suffering from severe traumatic brain injury, NT-proBNP levels in cerebral spinal fluid and serum were significantly elevated in patients exhibiting an ICP of more than 15 mmHg.108 In a prospective cohort study incorporating 300 patients with aneurysmal SAH, an initial BNP level greater than 600 pg/mL was markedly associated with death.109 "
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ABSTRACT: Natriuretic peptides (NPs) have been found to be useful markers in differentiating acute dyspneic patients presenting to the emergency department (ED) and emerged as potent prognostic markers for patients with congestive heart failure (CHF). The best-established and widely used clinical application of BNP and NT-proBNP testing is for the emergent diagnosis of CHF in patients presenting with acute dyspnea. Nevertheless, elevated NPs levels can be found in many circumstances involving left ventricular (LV) dysfunction or hypertrophy; right ventricular (RV) dysfunction secondary to pulmonary diseases; cardiac inflammatory or infectious diseases; endocrinology diseases and high output status without decreased LV ejection fraction. Even in the absence of significant clinical evidence of volume overload or LV dysfunction, markedly elevated NP levels can be found in patients with multiple comorbidities with a certain degree of prognostic value. Potential clinical applications of NPs are expanded accompanied by emerging reports regarding screening the presence of secondary cardiac dysfunction; monitoring the therapeutic responses, risk stratifications and providing prognostic values in many settings. Clinicians need to have expanded knowledge regarding the interpretation of elevated NPs levels and potential clinical applications of NPs. Clinicians should recognize that currently the only reasonable application for routine practice is limited to differentiation of acute dyspnea, rule-out-diagnostic-tests, monitoring of therapeutic responses and prognosis of acute or decompensated CHF. The rationales as well the potential applications of NPs in these settings are discussed in this review article.
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ABSTRACT: cardiac injury occurs frequently after stroke; and the most widely investigated form of neurocardiogenic injury is aneurysmal subarachnoid hemorrhage. Echocardiography and screening for elevated troponin and B-type natriuretic peptide levels may help prognosticate and guide treatment of stroke. Cardiac catheterization is not routinely recommended in subarachnoid hemorrhage patients with left ventricular dysfunction and elevated troponin. The priority should be treatment of the underlying neurologic condition, even in patients with left ventricular dysfunction. Cardiac injury that occurs after subarachnoid hemorrhage appears to be reversible. In contrast to subarachnoid hemorrhage patients, patients with ischemic stroke are more likely to have concomitant significant heart disease. For patients who develop brain death, cardiac evaluation under optimal conditions may help increase the organ donor pool.
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