Cardiovascular Predictors of In-Patient Mortality After Subarachnoid Hemorrhage

Yarlagadda, Sirisha; Rajendran, Pam R.; Miss, Jacob C.; Banki, Nader M.; Kopelnik, Alexander; Wu, Alan H.B.; Ko, Nerissa; Gelb, Adrian W.; Lawton, Michael T.; Smith, Wade S.; Young, William L.; Zaroff, Jonathan G.

doi:10.1385/ncc:5:2:102

Cited by 75 publications

(52 citation statements)

References 26 publications

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“…Hemorrhagic shock also causes decreased cardiac output, stroke volume and cardiac contractility (±dP/dt) (1)(2)(3). Hypoxia and reperfusion injury result in dysregulation of critical molecular pathways and bioprocesses (4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Resveratrol Improves Cardiac Contractility following Trauma-Hemorrhage by Modulating Sirt1

Jian

Yang

Chaudry

et al. 2011

Mol Med

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Mitochondria play a critical role in metabolic homeostasis of a cell. Our recent studies, based on the reported interrelationship between c-Myc and Sirt1 (mammalian orthologue of yeast sir2 [silent information regulator 2]) expression and their role in mitochondrial biogenesis and function, demonstrated a significant downregulation of Sirt1 protein expression and an upregulation of c-Myc following trauma-hemorrhage (T-H). Activators of Sirt1 are known to improve mitochondrial function and the naturally occurring polyphenol resveratrol (RSV) has been shown to significantly increase Sirt1 activity by increasing its affinity to both NAD+ and the acetylated substrate. In this study we tested the salutary effect of RSV following T-H and its influence on Sirt1 expression. Rats were subjected to T-H or sham operation. RSV (8 mg/kg body weight, intravenously) or vehicle was administered 10 min after the onset of resuscitation, and the rats were killed 2 h following resuscitation. Sirtinol, a Sirt1 inhibitor, was administered 5 min prior to RSV administration. Cardiac contractility (±dP/dt) was measured and heart tissue was tested for Sirt1, Pgc-1α, c-Myc, cytosolic cytochrome C expression and ATP level. Left ventricular function, after T-H, was improved (P < 0.05) following RSV treatment, with significantly elevated expression of Sirt1 (P < 0.05) and Pgc-1α (P < 0.05), and decreased c-Myc (P < 0.05). We also observed significantly higher cardiac ATP content, declined cytosolic cytochrome C and decreased plasma tumor necrosis factor-α in the T-H-RSV group. The salutary effect due to RSV was abolished by sirtinol, indicating a Sirt1-mediated effect. We conclude that RSV may be a useful adjunct to resuscitation fluid following T-H.

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Section: Introductionmentioning

confidence: 99%

Resveratrol Improves Cardiac Contractility following Trauma-Hemorrhage by Modulating Sirt1

Jian

Yang

Chaudry

et al. 2011

Mol Med

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“…Brain natriuretic peptide has also been explored as a marker of cardiac injury in SAH patients, and high BNP at admission as well as high troponin-I on the 3rd day after admission has been found to be associated with increased inpatient deaths. 28 Altogether, the studies so far suggest an association among SAH, complications in the heart and brain, and disturbances of fluid and salt balance. However, according to a literature review on SAH and BNP, only a few studies with a larger number of patients exist.…”

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confidence: 99%

“…Cardiovascular abnormalities after subarachnoid hemorrhage (SAH) have been shown to be independent predictors for inpatient death. 28 It has also been observed that natriuretic peptides, especially brain natriuretic peptide (BNP), increase in SAH patients.…”

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confidence: 99%

“…However, according to a literature review on SAH and BNP, only a few studies with a larger number of patients exist. 22,28 Another problem is that BNP has been measured at different time points and the results have been statistically treated in various ways: median values, mean values, and single values. Furthermore, earlier published studies almost exclusively compared BNP values with events during the intensive care phase.…”

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Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

Nyberg¹,

Karlsson

Ronne-Engström³

2014

JNS

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RuptuRe of an intracranial aneurysm is followed by an acute phase with a complex chain of events. Most obvious are the intracranial complications of clots, hydrocephalus, and brain ischemia in various degrees and combinations. Many patients also show serious systemic complications, probably as a result of the intracranial pathophysiology. It is generally thought that a main trigger for systemic changes is the increase in the intracranial pressure that occurs at the time of aneurysm rupture. The elevated intracranial pressure decreases cerebral blood flow and causes a transient or permanent global ischemia. A major stress reaction follows, including the release of adrenocorticotropic hormone, cortisol, Object. The rupture of an intracranial aneurysm is followed by increased intracranial pressure and decreased cerebral blood flow. A major systemic stress reaction follows, presumably to restore cerebral blood flow. However, this reaction can also cause adverse effects, including myocardial abnormalities, which are common and can be serious, and increased levels of natriuretic peptides, especially brain natriuretic peptide (BNP). The association of BNP with fluid and salt balance, vasospasm, brain ischemia, and cardiac injury has been studied but almost exclusively regarding events after admission. Brain natriuretic peptide has also been measured at various time points and analyzed in different ways statistically. The authors approached BNP measurement in a new way; they used the calculated area under the curve (AUC) for the first 4 days to quantitatively measure the BNP load during the first critical part of the disease state. Their rationale was a suspicion that early BNP load is a marker of the severity of the ictus and will influence the subsequent course of the disease by disturbing the fluid and salt balance.Methods. The study included 156 patients with acute spontaneous subarachnoid hemorrhage (SAH). Mean patient age was 59.8 ± 11.2 years, and 105 (67%) of the patients were female. An aneurysm was found in 138 patients. A total of 82 aneurysms were treated by endovascular coiling, 50 were treated by surgery, and 6 were untreated. At the time of admission, serum samples were collected for troponin-I analysis and for the N-terminal prohormone of BNP (NT-proBNP); daily thereafter, samples were collected for the NT-proBNP analysis. The cumulative BNP load was calculated as the AUC for NT-proBNP during the first 4 days. The following variables were studied in terms of their influence on the AUC for NT-proBNP: sex, age, World Federation of Neurosurgical Societies grade of SAH, Fisher grade, angiographic result, treatment of aneurysm, clinical neurological deterioration, verified infections, vasospasm treatment, and 6-month outcome.Results. The AUC for NT-proBNP was larger when variables indicated a more severe SAH. These variables were higher Fisher and World Federation of Neurosurgical Societies grades, high levels of troponin-I at admission, an aneurysm, neurological deficits, and infections. The AUC for NT-proBN...

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“…myocardial injury, [9][10][11][12][13][14] and left ventricular (LV) dysfunction, 9,13) occur early in the course of SAH. The pathophysiology of these abnormalities is related to increased sympathetic nervous activity 15) and to increased circulating and local myocardial tissue catecholamines.…”

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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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Cardiovascular Predictors of In-Patient Mortality After Subarachnoid Hemorrhage

Abstract: 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.

Cited by 75 publications

References 26 publications

Resveratrol Improves Cardiac Contractility following Trauma-Hemorrhage by Modulating Sirt1

Resveratrol Improves Cardiac Contractility following Trauma-Hemorrhage by Modulating Sirt1

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

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

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