Cardiac Troponin Elevation, Cardiovascular Morbidity, and Outcome After Subarachnoid Hemorrhage

Naidech, Andrew M.; Kreiter, Kurt T.; Janjua, Nazli; Ostapkovich, Noeleen; Parra, Augusto; Commichau, Christopher; Fitzsimmons, Brian‐Fred; Connolly, E. Sander; Mayer, Stephan A.

doi:10.1161/circulationaha.105.533620

Cited by 304 publications

(248 citation statements)

References 26 publications

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“…The study concluded that cTnI elevation after SAH is associated with an increased risk of cardiopulmonary complications, delayed cerebral ischemia, and death or poor functional outcome at discharge. 17,43 Troponin elevation has also been reported in diabetic ketoacidosis. Metabolic derangement, fluid shifts, tachycardia, and increased sympathetic tone may trigger focal myocardial necrosis and Tn release.…”

Section: Clinical Significance Of Troponin Elevation In Absence Of Acmentioning

confidence: 92%

A Review of Causes and Systemic Approach to Cardiac Troponin Elevation

Patil

Vaidya

Bogart

2011

Clinical Cardiology

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The first American College of Cardiology/European Society of Cardiology task force published recommendations for a universal definition of myocardial infarction (MI) in 2000 based on the measurement of troponin (Tn). Although this rapid and highly sensitive blood test is certainly valuable in the appropriate setting, its widespread use in variety of clinical scenarios may lead to the detection of Tn elevation in absence of thrombotic acute coronary syndrome. In 2007, the joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation task force proposed a new definition for acute MI based on detection of Tn and associated clinical evidence. The goal of this article is to review the universal definition of acute MI and to differentiate type 1 MI, type 2 MI, and non–acute coronary syndrome Tn elevations. The prognosis and a clinical approach to this differential diagnosis will be developed. © 2011 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Section: Clinical Significance Of Troponin Elevation In Absence Of Acmentioning

confidence: 92%

A Review of Causes and Systemic Approach to Cardiac Troponin Elevation

Patil

Vaidya

Bogart

2011

Clinical Cardiology

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“…6,7 Starting in May 2003, patients with SAH received EACA at the time of diagnosis. EACA (4 g IV) was administered as a loading dose followed by 1 g/h, with cessation of infusion 4 hours before angiography for a maximum duration of 72 hours after SAH onset.…”

Section: Methods Patientsmentioning

confidence: 99%

“…7 Deep venous thrombosis (DVT) was determined by Doppler ultrasonography. Outcome was assessed with the Modified Rankin Scale score at discharge and at 3 months.…”

Section: Study Outcomesmentioning

confidence: 99%

Impact of a Protocol for Acute Antifibrinolytic Therapy on Aneurysm Rebleeding After Subarachnoid Hemorrhage

Starke

Kim

Fernandez

et al. 2008

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Background and Purpose--Aminocaproic acid (EACA) is an antifibrinolytic agent used to prevent rebleeding in aneurysmal subarachnoid hemorrhage. Although studies have found that a decrease in rebleeding with long-term antifibrinolytic therapy is offset by an increase in ischemic deficits, more recent studies have indicated that early, short-term therapy may be beneficial. Methods-We instituted a protocol for acute EACA administration starting at diagnosis and continued for a maximum duration of 72 hours after subarachnoid hemorrhage onset. We compared 73 patients treated with EACA with 175 non-EACA-treated patients. We sought to identify differences in the occurrence of rebleeding, side effects, and outcome. Results-Baseline characteristics were similar in the 2 groups. There was a significant decrease in rebleeding in EACA-treated patients (2.7%) versus non-EACA patients (11.4%). There was no difference in ischemic complications between cohorts. There was a significant 8-fold increase in deep venous thrombosis in the EACA group but no increase in pulmonary embolism. There was a nonsignificant 76% reduction in mortality attributable to rebleeding, a 13.3% increase in favorable outcome in good-grade EACA-treated patients, and a 6.8% increase in poor-grade patients. Conclusions-When used acutely, short-term EACA treatment resulted in decreased rebleeding without an increase in serious side effects in our selected group of patients. Randomized placebo-controlled trials are needed to determine whether acute antifibrinolytic therapy should be accepted as the standard of care in all patients.

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“…We also did not measure cardiac enzymes. Recent studies have shown that measurements of cardiac troponin I 30) and B-type natriuretic peptide 12) may provide additional prognostic information in SAH patients. Finally, the frequency and severity of arrhythmias were not determined, although continuous ECG monitoring did not demonstrate serious arrhythmias during the stay in the neurological care unit.…”

Section: Dysfunction In Sahmentioning

confidence: 99%

Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

et al. 2008

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SUMMARYLeft ventricular (LV) dysfunction generally occurs early in the course of subarachnoid hemorrhage (SAH). We evaluated the prognostic value of electrocardiographic (ECG) abnormalities and echocardiographic LV dysfunction evaluated shortly after SAH.We prospectively enrolled 47 SAH patients (62 ± 14 years, mean ± SD) who were admitted to the neurosurgical care unit of our institute. Neurological status was rated on the day of admission. Twelve-lead ECG and 2-dimensional echocardiography were recorded 2 ± 1 day after onset of SAH. ECG abnormalities (pathological Q-wave, ST-segment deviation, T-wave inversion, and QT prolongation) were evaluated and the incidences of global (LV ejection fraction < 50%) and segmental (regional wall motion abnormality [RWMA]) LV dysfunction were measured.During a follow-up period of 44 ± 23 days, 17 (36%) patients died. ECG abnormalities, LV ejection fraction < 50%, and RWMA were observed in 62%, 11%, and 28% of patients, respectively. Univariate Cox proportional hazards regression analysis revealed that neurological status, rate-corrected QT interval, LV ejection fraction, and RWMA were significant predictors of death. After adjustment for these significant clinical variables, and age and sex, independent predictors of mortality were neurological status and RWMA.RWMA may provide significant prognostic information in patients with SAH. (Int Heart J 2008; 49: 75-85)

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Cardiac Troponin Elevation, Cardiovascular Morbidity, and Outcome After Subarachnoid Hemorrhage

Cited by 304 publications

References 26 publications

A Review of Causes and Systemic Approach to Cardiac Troponin Elevation

A Review of Causes and Systemic Approach to Cardiac Troponin Elevation

Impact of a Protocol for Acute Antifibrinolytic Therapy on Aneurysm Rebleeding After Subarachnoid Hemorrhage

Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

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