Cardiac Injury after Subarachnoid Hemorrhage Is Independent of the Type of Aneurysm Therapy

Miss, Jacob C.; Kopelnik, Alexander; Fisher, Landis A.; Tung, Poyee P.; Banki, Nader M.; Lawton, Michael T.; Smith, Wade S.; Dowd, Christopher F.; Zaroff, Jonathan G.

doi:10.1227/01.neu.0000143165.50444.7f

Cited by 39 publications

(15 citation statements)

References 35 publications

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“…Most patients achieve complete or partial resolution of stunned myocardium during their initial hospitalization. There is no important difference in cardiac outcomes after surgical aneurysm clipping versus percutaneous aneurysm coiling [44].…”

Section: Prognosismentioning

confidence: 99%

Neurogenic stunned myocardium

Nguyen

Zaroff

2009

Curr Neurol Neurosci Rep

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143

126

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Neurogenic stunned myocardium may be defined as myocardial injury and dysfunction occurring after diverse types of acute brain injury as a result of imbalance of the autonomic nervous system. The spectrum of observed cardiac abnormalities includes electrocardiographic changes, arrhythmia, myocardial necrosis, release of B-type natriuretic peptide, and both systolic and diastolic dysfunction of the left ventricle. These are reversible abnormalities, and although management should include careful cardiac monitoring, treatments should generally focus on the underlying neurologic process to maximize neurologic recovery.

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Section: Prognosismentioning

confidence: 99%

Neurogenic stunned myocardium

Nguyen

Zaroff

2009

Curr Neurol Neurosci Rep

Self Cite

143

126

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“…Interestingly, it has been reported that endovascular coiling or surgical clipping of ruptured aneurysms is not associated with the incidence of cardiac injury or dysfunction [84]. However, it is important to note that treatment decisions were made on the basis of standard practice patterns rather than on a randomization process.…”

Section: Manifestations Of Nonneurologic Complications After Sahmentioning

confidence: 99%

The Harmful Effects of Subarachnoid Hemorrhage on Extracerebral Organs

Chen

et al. 2014

BioMed Research International

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Subarachnoid hemorrhage (SAH) is a devastating neurological disorder. Patients with aneurysmal SAH develop secondary complications that are important causes of morbidity and mortality. Aside from secondary neurological injuries, SAH has been associated with nonneurologic medical complications, such as neurocardiogenic injury, neurogenic pulmonary edema, hyperglycemia, and electrolyte imbalance, of which cardiac and pulmonary complications are most common. The related mechanisms include activation of the sympathetic nervous system, release of catecholamines and other hormones, and inflammatory responses. Extracerebral complications are directly related to the severity of SAH-induced brain injury and indicate the clinical outcome in patients. This review provides an overview of the extracerebral complications after SAH. We also aim to describe the manifestations, underlying mechanisms, and the effects of those extracerebral complications on outcome following SAH.

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“…3 Patients with aneurysmal SAH had an increase in systematic and local norepinephrine release 4–7 that may have been related to myocardial injury deflected by increased serum cardiac troponin I (cTnI). 2,8,9 Cardiac troponin is the current standard method of serologic detection of myocardial injury in patients with acute coronary syndromes. 10 In addition, increases in cTnI were associated with increased mortality in critically ill patients, 11 and even slight increases in cTnI (≥0.04 ng/ml) were associated with increased mortality rates in patients with advanced chronic heart failure.…”

mentioning

confidence: 99%

Relation of Elevation in Cardiac Troponin I to Clinical Severity, Cardiac Dysfunction, and Pulmonary Congestion in Patients With Subarachnoid Hemorrhage

Takao

Crago

Suffoletto

et al. 2008

The American Journal of Cardiology

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An increase in cardiac troponin I (cTnI) occurs often after aneurysmal subarachnoid hemorrhage (SAH), but its significance is not well understood. One hundred three patients with SAH were prospectively evaluated in the SAHMII Study to determine the relations of cTnI to clinical severity, systolic and diastolic cardiac function, pulmonary congestion, and length of intensive care unit stay. Echocardiographic ejection fraction, wall motion score, mitral inflow early diastolic (E) and mitral annular early (E′) velocities were assessed. Thirty patients (29%) had mildly positive cTnI (0.1 to 1.0 ng/ml), 24 (23%) had highly positive cTnI (>1.0 ng/ml), and 49 (48%) had negative cTnI (<0.1 ng/ml). Highly positive cTnI was associated with worse neurologic disease, longer intensive care unit stay, and slight depression of ejection fraction (51 ± 11% [p <0.05] vs 59 ± 8% and 63 ± 6% in mildly positive or negative cTnI groups, respectively). Highly positive cTnI was also associated with abnormal wall motion acutely (>1.31 ng/ml; 76% sensitivity, 91% specificity), which typically resolved within 5 to 10 days. Both mildly or highly positive cTnI were associated with acute diastolic dysfunction, with E/E′ of 17 ± 6 and 16 ± 6 (both p <0.05) vs 13 ± 4 in patients with negative cTnI. Prevalences of pulmonary congestion were 79% (p <0.05) in patients with highly positive cTnI, 53% (p <0.05) in patients with mildly positive cTnI, and 29% in cTnI-negative patients. In conclusion, highly positive cTnI with SAH was associated with clinical neurologic severity, systolic and diastolic cardiac dysfunction, pulmonary congestion, and longer intensive care unit stay. Even mild increases in cTnI were associated with diastolic dysfunction and pulmonary congestion.

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Cardiac Injury after Subarachnoid Hemorrhage Is Independent of the Type of Aneurysm Therapy

Abstract: Surgical and endovascular aneurysm therapies were associated with similar risks of cardiac injury and dysfunction after SAH. The presence of neurocardiogenic injury should not affect aneurysm treatment decisions.

Cited by 39 publications

References 35 publications

Neurogenic stunned myocardium

Neurogenic stunned myocardium

The Harmful Effects of Subarachnoid Hemorrhage on Extracerebral Organs

Relation of Elevation in Cardiac Troponin I to Clinical Severity, Cardiac Dysfunction, and Pulmonary Congestion in Patients With Subarachnoid Hemorrhage

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