Levosimendan as a therapeutic strategy to prevent neuroinflammation after aneurysmal subarachnoid hemorrhage?

Wanderer, Stefan; Andereggen, Lukas; Mrosek, Jan; Kashefiolasl, Sepide; Schubert, Gerrit Alexander; Marbacher, Serge; Konczalla, Juergen

doi:10.1136/neurintsurg-2021-017504

Cited by 8 publications

(6 citation statements)

References 30 publications

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“…Although improvement has been made in the treatment of aSAH in recent years, the prognosis of some patients is still poor. [11] In recent years, there were some studies confirming the important role of neuroinflammation in the progression of stroke [12][13][14] and exploring the relationships between inflammatory indicators and prognosis of patients. Counts of White blood cells and neutrophils were shown to be associated with the GCS score, the hemorrhage volume and the 90-day prognosis of cerebral hemorrhage patients.…”

Section: Discussionmentioning

confidence: 99%

Systemic immune inflammation index and system inflammation response index on the third postoperative day predict poor prognosis of aneurysmal subarachnoid hemorrhage patients

Wang,

Tian,

Zhao

et al. 2024

Medicine

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The inflammatory response is involved in the progression of aneurysmal subarachnoid hemorrhage (aSAH). We sought to investigate the relationships of inflammatory indicators including blood cell counts and the ratios of different blood cells counts with the prognosis of aSAH patients. We performed a retrospective study including 140 patients with aSAH and aneurysm surgeries. The relationships of neutrophils, lymphocytes, monocytes, platelets, systemic immune inflammation index (SII), system inflammation response index (SIRI), neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with prognosis were investigated by univariable analysis and multivariable logistic regression model. The patient with Modified Rankin Scale (mRS) score＜3 was defined as having a good prognosis, while with mRS score ≥3 was defined as having a poor prognosis. Among 140 patients included, there were 108 cases with good prognosis and 32 cases with poor prognosis after follow-up. On the 3rd postoperative day, the neutrophils counts, SIRI level and SII level in cases with poor prognosis were significantly higher than cases with good prognosis, P < .05. After adjusting for baseline differences in Hunt-Hess grade, Glasgow Coma Scale score, combination with intraventricular hemorrhage and maximum diameter of aneurysm, the levels of SIRI (odds ratio = 3.968, 95% CI: 1.432–10.992, P = .008) and SII (odds ratio = 3.313, 95% CI: 1.029–10.665, P = .045) on the 3rd postoperative day could predict poor prognosis. SII and SIRI on the 3rd postoperative day could independently predict the poor prognosis in aSAH. However, the cutoff values for predicting prognosis needs to be validated in larger-sample studies.

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Section: Discussionmentioning

confidence: 99%

Systemic immune inflammation index and system inflammation response index on the third postoperative day predict poor prognosis of aneurysmal subarachnoid hemorrhage patients

Wang,

Tian,

Zhao

et al. 2024

Medicine

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“…It also has a vasodilator effect, decreases preload, and improves coronary perfusion and WMAs. Therefore, it is a promising therapeutic option for patients with or without cerebral vasospasm [ 44 , 48 , 59 ].…”

Section: Treatmentmentioning

confidence: 99%

Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review

Szántó¹,

Luterán²,

Gál³

et al. 2023

Rev. Cardiovasc. Med.

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Takotsubo syndrome (TS) is a frequent complication of subarachnoid hemorrhage (SAH), especially in massive SAH with severe neurological damage. The initial presentation of TS is similar to acute coronary syndrome, causing differential diagnostic issues. Unnecessary diagnostic steps and uncertainty in therapy may delay the definitive treatment of the aneurysm, therefore increasing the risk of rebleeding. The purpose of this review is to summarize the latest knowledge on the diagnosis and therapy of TS in SAH and to provide a diagnostic and therapeutic algorithm for the acute phase, promoting the early definitive treatment of the aneurysm. Rapid hemodynamic stabilization and early aneurysm securing are key points in reducing the risk of delayed cerebral ischemia and improving outcomes. In acute SAH noninvasive bedside diagnostic methods are preferred and securing the aneurysm is the priority. The combination of electrocardiography, cardiac biomarkers, and echocardiography is of great importance in differentiating TS from acute myocardial infarction. The risk-benefit ratio of coronary angiography should be carefully and individually considered and its use should be limited to patients with strong evidence of myocardial ischemia, after the successful endovascular treatment of the aneurysm. Invasive hemodynamic monitoring may be beneficial in cases of cardiogenic shock or pulmonary edema. In patients with hemodynamical instability secondary to TS, the use of non-catecholamine inotropes, especially levosimendan is recommended. In refractory hypotension, mechanical support should be considered. The left ventricular function improves within days to months after the acute event, low initial ejection fraction may predispose to delayed recovery.

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“…Given the significant role of cerebral inflammation in the development and progression of PHCV, levosimendan, a calciumchannel sensitizer with anti-inflammatory properties, has been explored as a therapeutic for PHCV [96,97]. Levosimendan has been shown to reduce vasoconstriction [96] and restore the functioning of the vasorelaxant ET-(B1) receptor [97] in rat models of PHCV.…”

Section: Emerging Preclinical Treatmentsmentioning

confidence: 99%

Prevention and treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

McGrath,

Hey,

Ebrahim

et al. 2023

Academia Biology

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Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) remains a significant cause of morbidity and mortality. Posthemorrhage cerebral vasospasm (PHCV) occurs through a complex pathophysiology, and numerous pharmacologic agents, including vasodilators, anti-inflammatories, and fibrinolytics, as well as endovascular techniques have been used to prevent and/or treat PHCV. Nimodipine continues to be the only agent with level 1 evidence, but other vasodilators have demonstrated promising results. Endovascular therapy likely has a role in treating severe/refractory PHCV, but randomized trials are needed to establish stronger evidence for this therapy. Numerous preclinical investigations highlight novel targets related to the immune response that could prove effective at improving outcomes in clinical trials. Further investigation of the glymphatic system and its role in PHCV pathogenesis could result in novel pharmacologic targets. Future trials of these therapies and combinations of existing therapies are needed, and functional outcomes should be included as an endpoint. Further exploration of the neuroinflammatory reaction following aSAH will continue to identify targetable molecules involved in PHCV pathogenesis.

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Levosimendan as a therapeutic strategy to prevent neuroinflammation after aneurysmal subarachnoid hemorrhage?

Cited by 8 publications

References 30 publications

Systemic immune inflammation index and system inflammation response index on the third postoperative day predict poor prognosis of aneurysmal subarachnoid hemorrhage patients

Systemic immune inflammation index and system inflammation response index on the third postoperative day predict poor prognosis of aneurysmal subarachnoid hemorrhage patients

Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review

Prevention and treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

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