Cardiac dysfunction after aneurysmal subarachnoid hemorrhage

Bilt, Iac Van Der; Hasan, D.; Brink, R. van den; Cramer, Maarten J.; Jagt, Mathieu van der; Kooten, Fop van; Meertens, John H. J. M.; Berg, M. van den; Groen, Rob J. M.; Cate, Folkert J. ten; Kamp, Otto; Götte, Marco J.W.; Horn, Janneke; Groeneveld, JB; Vandertop, W. Peter; Algra, A.; Visser, Frans C.; Wilde, Arno de; Rinkel, Gabriël J.E.

doi:10.1212/wnl.0000000000000057

Cited by 90 publications

(69 citation statements)

References 36 publications

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“…As reported previously for patients with subarachnoid hemorrhage [21], elevation of troponin I levels may, on the one hand, result from intraventricular blood and, therefore, meningeal irritation, leading to strong systemic stress-responses [22,23]. As a result, an enhanced release of catecholamines and consequently higher myocardial stress may reflect a neurocardiac dysbalance, evident also after ICH, notably in those patients with intraventricular involvement [21,22,24]. In addition, up to now, the longitudinal occurrence of troponin elevations in ICH patients was only insufficiently established and pathophysiological considerations further include an increase of intracranial pressure additionally triggering sympathetic storms [10,21,[24][25][26].…”

Section: Discussionmentioning

confidence: 56%

“…Assessment of serial troponin I levels during hospital stay revealed a further increase in the rate of elevated troponin levels, a finding predominantly driven by increased ventricular involvement. As reported previously for patients with subarachnoid hemorrhage [21], elevation of troponin I levels may, on the one hand, result from intraventricular blood and, therefore, meningeal irritation, leading to strong systemic stress-responses [22,23]. As a result, an enhanced release of catecholamines and consequently higher myocardial stress may reflect a neurocardiac dysbalance, evident also after ICH, notably in those patients with intraventricular involvement [21,22,24].…”

Section: Discussionmentioning

confidence: 84%

“…As a result, an enhanced release of catecholamines and consequently higher myocardial stress may reflect a neurocardiac dysbalance, evident also after ICH, notably in those patients with intraventricular involvement [21,22,24]. In addition, up to now, the longitudinal occurrence of troponin elevations in ICH patients was only insufficiently established and pathophysiological considerations further include an increase of intracranial pressure additionally triggering sympathetic storms [10,21,[24][25][26]. To protect patients with cerebrovascular diseases from this excessive stress, the use of beta-blockers is currently discussed [27,28]; however, this treatment is currently not considered in current guidelines for ICH-patients [29].…”

Section: Discussionmentioning

confidence: 99%

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Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

et al. 2018

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Background: Troponin I is a widely used and reliable marker of myocardial damage and its levels are routinely measured in acute stroke care. So far, the influence of troponin I elevations during hospital stay on functional outcome in patients with atraumatic intracerebral hemorrhage (ICH) is unknown. Methods: Observational single-center study including conservatively treated ICH patients over a 9-year period. Patients were categorized according to peak troponin I level during hospital stay (≤0.040, 0.041–0.500, > 0.500 ng/mL) and compared regarding baseline and hematoma characteristics. Multivariable analyses were performed to investigate independent associations of troponin levels during hospital stay with functional outcome – assessed using the modified Rankin Scale (mRS; favorable 0–3/unfavorable 4–6) – and mortality after 3 and 12 months. To account for possible confounding propensity score (PS)-matching (1: 1; caliper 0.1) was performed accounting for imbalances in baseline characteristics to investigate the impact of troponin I values on outcome. Results: Troponin elevations (> 0.040 ng/mL) during hospital stay were observed in 308 out of 745 (41.3%) patients and associated with poorer status on admission (Glasgow Coma Scale/National Institute of Health Stroke Scale). Multivariable analysis revealed troponin I levels during hospital stay to be independently associated with unfavorable outcome after 12 months (risk ratio [95% CI]: 1.030 [1.009–1.051] per increment of 1.0 ng/mL; p = 0.005), but not with mortality. After PS-matching, patients with troponin I elevation (≥0.040 ng/mL) versus those without had a significant higher rate of unfavorable outcome after 3 and 12 months (mRS 4–6 at 3 months: < 0.04 ng/mL: 159/265 [60.0%] versus ≥0.04 ng/mL: 199/266 [74.8%]; p < 0.001; at 12 months: < 0.04 ng/mL: 141/248 [56.9%] versus ≥0.04 ng/mL: 179/251 [71.3%]; p = 0.001). Conclusions: Troponin I elevations during hospital stay occur frequently in ICH patients and are independently associated with functional outcome after 3 and 12 months but not with mortality.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

et al. 2018

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“…Until now, authors have extrapolated from data in the cardiologic literature in an attempt to set a threshold for normal GLS values in ICU ventilated patients. In a large Norwegian multi-centric nation-wide study [27], the authors studied 1,266 healthy subjects. Although global longitudinal strain increases with age (implying strain impairment), the overall normal global longitudinal strain was -17.4%.…”

Section: Systolic Function Assessed With Ste In Patients Undergoinmentioning

confidence: 99%

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Cinotti¹,

Delater²,

Fortuit³

et al. 2015

Anaesthesiol Intensive Ther

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Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its novelty relies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium during the cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date, global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is more sensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment. It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensive care unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-tracking analysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggest that GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients, speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gaps to fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated, and there are, to date, too few data to exactly assess potential GLS alterations on the patient's outcome. Nonetheless, this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may be of primary interest in the evaluation of left-ventricular systolic function in the ICU.

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“…Previous studies have shown that development of NCM predicts poor neurological outcome [1,11]. However, much less is known about these patients' cardiac outcomes, and if cardiac dysfunction persists and further complicates neurological recovery.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes after neurogenic stress induced cardiomyopathy in aneurysmal sub-arachnoid hemorrhage: A prospective cohort study

Kilbourn

Ching

Silverman

et al. 2015

Clinical Neurology and Neurosurgery

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Cardiac dysfunction after aneurysmal subarachnoid hemorrhage

Abstract: WMAs are independent risk factors for clinical outcome after aSAH. This relation is partly explained by a higher risk of DCI. Further study should aim at treatment strategies for these aSAH-related cardiac abnormalities to improve clinical outcome.

Cited by 90 publications

References 36 publications

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Clinical outcomes after neurogenic stress induced cardiomyopathy in aneurysmal sub-arachnoid hemorrhage: A prospective cohort study

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