Cardiovascular Protection to Improve Clinical Outcomes After Subarachnoid Hemorrhage: Is There a Proven role?

Okabe, Toshimasa; Kanzaria, Mitul; Rincón, Fred; Kraft, Walter K.

doi:10.1007/s12028-012-9804-z

Cited by 16 publications

(6 citation statements)

References 87 publications

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“…The awareness of the possible presence of cardiac injury in these patients and its impact on patient outcome might raise the attention toward cardiac protection in cases with higher risk. Although there is no consensus till now about the efficacy of any mode of cardiac protection in neurosurgical patients [ 27 ], a possible role for propranolol and phentolamine in cardiac protection was suggested by Neil-Dwyer and colleagues [ 28 ] who reported the absence of myocardial necrosis in post-mortem specimens for patients with SAH who received these drugs. However, this finding had no impact on patient outcome.…”

Section: Discussionmentioning

confidence: 99%

Incidence and outcome of cardiac injury in patients with severe head trauma

Hasanin

Kamal

Amin

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundAlthough cardiac injury has been reported in patients with various neurological conditions, few data report cardiac injury in patients with traumatic brain injury (TBI). The aim of this work is to report the incidence of cardiac injury in patients with TBI and its impact on patient outcome.MethodsA prospective observational study was conducted on a cohort of 50 patients with severe TBI. Only patients with isolated severe TBI defined as Glascow coma scale (GCS) < 8 were included in the study. Acute physiology and chronic health evaluation (APACHE) II score, GCS, hemodynamic data, serum Troponin I, electrocardiogram (ECG), and echocardiographic examination, and patients’ outcome were recorded. A neurogenic cardiac injury score (NCIS) was calculated for all patients (rising troponin = 1, abnormal echocardiography = 1, hypotension = 1). Univariate and multivariate analyses for risk factors for mortality were done for all risk factors.Results and discussionFifty patients were included; age was 31 ± 12, APACHE II was 21 ± 5, and male patients were 45 (90 %). Troponin I was elevated in 27 (54 %) patients, abnormal echocardiography and hypotension were documented in 14 (28 %) and 16 (32 %) patients, respectively. The in-hospital mortality was 36 %. Risk factors for mortality by univariate analysis were age, GCS, APACHE II score, serum troponin level, NCIS, and hypotension. However, in multivariate analysis, the only two independent risk factors for mortality were APACHE II score (OR = 1.25, 95 % confidence interval: 1.02–1.54, P = 0.03) and NCIS score (OR = 8.38, 95 % confidence interval: 1.44–48.74, P = 0.018).ConclusionsCardiac injury is common in patients with TBI and is associated with increased mortality. The association of high NCIS and poor outcome in these patients warrants a further larger study.

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Section: Discussionmentioning

confidence: 99%

Incidence and outcome of cardiac injury in patients with severe head trauma

Hasanin

Kamal

Amin

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…104 Whether treatments are available that can induce cardioprotection and hence improve clinical outcomes after SAH is still unknown and needs to be tested in clinical trials. 105…”

Section: Proposed Treatment For Nscmentioning

confidence: 99%

Brain–heart crosstalk: the many faces of stress-related cardiomyopathy syndromes in anaesthesia and intensive care

Mazzeo

Micalizzi

Mascia

et al. 2014

British Journal of Anaesthesia

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Neurogenic stress cardiomyopathy (NSC) is a well-known syndrome complicating the early phase after an acute brain injury, potentially affecting outcomes. This article is a review of recent data on the putative role of localization and lateralization of brain lesions in NSC, cardiac innervation abnormalities, and new polymorphisms and other genetic causes of the sympathetic nervous system over-activity. Concerns regarding the management of stress-related cardiomyopathy syndromes during the perioperative period are also discussed. Future clinical research should explore whether specific factors explain different patient susceptibilities to the disease and should be directed towards early identification and stratification of patients at risk, so that such patients can be more carefully monitored and appropriately managed in critical care and during the perioperative period.

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“…Data concerning the impact of cardiac abnormalities on the occurrence of cVSP have also been limited. 19 In fact, cardiac function abnormalities are common following aSAH (in up to 33% of cases) and may influence clinical outcomes and the occurrence of cVSP. 20 The purpose of the present study was to assess the impact of preadmission BB therapy and cardiac function abnormalities on the incidence of cVSP and inhospital mortality following aSAH.…”

mentioning

confidence: 99%

Beta-blocker therapy and impact on outcome after aneurysmal subarachnoid hemorrhage: a cohort study

Chalouhi¹,

Daou²,

Okabe³

et al. 2016

JNS

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OBJECTIVE Cerebral vasospasm (cVSP) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), with a significant impact on outcome. Beta blockers (BBs) may blunt the sympathetic effect and catecholamine surge associated with ruptured cerebral aneurysms and prevent cardiac dysfunction. The purpose of this study was to investigate the association between preadmission BB therapy and cVSP, cardiac dysfunction, and in-hospital mortality following aSAH. METHODS This was a retrospective cohort study of patients with aSAH who were treated at a tertiary high-volume neurovascular referral center. The exposure was defined as any preadmission BB therapy. The primary outcome was cVSP assessed by serial transcranial Doppler with any mean flow velocity ≥ 120 cm/sec and/or need for endovascular intervention for medically refractory cVSP. Secondary outcomes were cardiac dysfunction (defined as cardiac troponin-I elevation > 0.05 μg/L, low left ventricular ejection fraction [LVEF] < 40%, or LV wall motion abnormalities [LVWMA]) and in-hospital mortality. RESULTS The cohort consisted of 210 patients treated between February 2009 and September 2010 (55% were women), with a mean age of 53.4 ± 13 years and median Hunt and Hess Grade III (interquartile range III-IV). Only 13% (27/210) of patients were exposed to preadmission BB therapy. Compared with these patients, a higher percentage of patients not exposed to preadmission BBs had transcranial Doppler-mean flow velocity ≥ 120 cm/sec (59% vs 22%; p = 0.003). In multivariate analyses, lower Hunt and Hess grade (OR 3.9; p < 0.001) and preadmission BBs (OR 4.5; p = 0.002) were negatively associated with cVSP. In multivariate analysis, LVWMA (OR 2.7; p = 0.002) and low LVEF (OR 1.1; p = 0.05) were independent predictors of in-hospital mortality. Low LVEF (OR 3.9; p = 0.05) independently predicted medically refractory cVSP. The in-hospital mortality rate was higher in patients with LVWMA (47.4% vs 14.8%; p < 0.001). CONCLUSIONS The study data suggest that preadmission therapy with BBs is associated with lower incidence of cVSP after aSAH. LV dysfunction was associated with higher medically refractory cVSP and in-hospital mortality. BB therapy may be considered after aSAH as a cardioprotective and cVSP preventive therapy.

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Cardiovascular Protection to Improve Clinical Outcomes After Subarachnoid Hemorrhage: Is There a Proven role?

Cited by 16 publications

References 87 publications

Incidence and outcome of cardiac injury in patients with severe head trauma

Incidence and outcome of cardiac injury in patients with severe head trauma

Brain–heart crosstalk: the many faces of stress-related cardiomyopathy syndromes in anaesthesia and intensive care

Beta-blocker therapy and impact on outcome after aneurysmal subarachnoid hemorrhage: a cohort study

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