Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms

Kuroiwa, Toshihiko; Morita, Hiroshi; Tanabe, Harushi; Ohta, Tomio

doi:10.1007/bf01420064

Cited by 69 publications

(36 citation statements)

References 23 publications

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“…2). These data were in line with the previous findings in literature reporting significantly inverse correlation between LVEF and cTnT (Kuroiwa et al 1995;Bhagat et al 1997;Panteghini et al 2002).…”

Section: Discussionsupporting

confidence: 93%

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Serum Cardiac Troponin T Levels as an Indicator of Myocardial Injury in Ischemic and Hemorrhagic Stroke Patients

Apak

İltümür

Tamam

et al. 2005

Tohoku J. Exp. Med.

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Many studies in the literature have clearly shown the increase in creatine kinase-myocardial subfraction (CK-MB) levels and changes in electrocardiography (ECG) after stroke. However, the studies on cardiac troponin T (cTnT) which is more sensitive and specific to myocardium after stroke are relatively scarce. Moreover, its associations with volume of stroke lesions and type of stroke have not been investigated thoroughly. Thus, the aims of this study were to investigate a predictive value of cTnT in assessing myocardial injury and cardiac dysfunction in different types of stroke (hemorrhagic or ischemic stroke) and its relationship with stroke size and volume. This study included 62 patients (30 males and 32 females) with acute stroke confirmed by computed tomography (CT). Blood samples were obtained within 24 hours of stroke onset to measure the serum levels of creatin kinase (CK), CK-MB, lactate dehydrogenate (LDH), and cTnT. ECG and echocardiography were performed to assess myocardial function and left ventricular ejection fraction (LVEF). Of all patients included in the study, 20 patients (32%) demonstrated elevations in cTnT, while 28 patients (45%) had increased CK-MB levels. Serum levels of cTnT were positively correlated with stroke volume (r = 0.65, p < 0.0001), while inversely correlated with LVEF (r = −0.53, p < 0001). Serum levels of both CK-MB and cTnT were higher in patients with hemorrhagic stroke than those with ischemic stroke but this difference was not significant (p > 0.05). As a conclusion, cTnT has a higher specificity and sensitivity in detecting myocardial injury after stroke of both ischemic and hemorrhagic origins. Measurement of the serum levels of cTnT is of clinical importance in evaluating myocardial injury and provides a useful aid in estimating the volume of stroke lesions. cardiac troponin T; creatine kinase-MB; stroke; myocardial injury; stroke volume © 2005 Tohoku University Medical PressStroke is defined as the primer pathology of brain vascular system that temporarily or permanently affects brain functions as a result of ischemia or hemorrhage. Due to consequent high mortality and morbidity rates, stroke is to become a major community health problem for whole

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Section: Discussionsupporting

confidence: 93%

“…Many studies in the literature clearly depicted the increase in CK-MB levels and changes in ECG after stroke (Norris et al 1979;Rudehill et al 1982;Brouwers et al 1989;Kuroiwa et al 1995). However the studies searching for cTnT which is more sensitive and specific to myocardium after stroke, is relatively scarce (James et al 2000;Parekh et al 2000).…”

Section: )mentioning

confidence: 99%

Serum Cardiac Troponin T Levels as an Indicator of Myocardial Injury in Ischemic and Hemorrhagic Stroke Patients

Apak

İltümür

Tamam

et al. 2005

Tohoku J. Exp. Med.

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“…ST elevations seem to resolve while 'T' wave inversions appear to persisteven for months/years [13,14].…”

Section: Prevalence Of Ecg Abnormalities In Sahmentioning

confidence: 99%

ECG Changes in Subarachnoid Haemorrhage: A Synopsis

Chatterjee

2010

Neth Heart J

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Subarachnoid haemorrhage (SAH) is a neurological emergency with high mortality rates. It is mainly caused by rupture of an aneurysm (congenital/infectious/ traumatic) or rupture of an arteriovenous malformation. Electrocardiograms (ECGs) done in patients with SAH have shown morphological changes as well as arrhythmias. Subarachnoid haemorrhage (SAH) patients have often been misdiagnosed to have cardiac abnormalities based on their ECGs when in many of those instances the ECG change had been the result of the SAH itself. They have led to unnecessary and wasteful investigations and therapies in many occasions. Hence the current article is an effort at consolidating the information available in an attempt to avoid possible errors in diagnosis by house staff and internists. There are two mechanisms that might mediate ECG changes in patients with SAH, i.e. autonomic neural stimulation from the hypothalamus or elevated levels of circulating catecholamine. Hypothalamic stimulation may cause ECG changes without associated myocardial damage whereas elevated catecholamine levels have been correlated with QT-interval prolongation and myocardial damage.

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“…15,16,18 Among these complications, delayed cerebral ischemia (DCI) remains an important cause of morbidity and death. 15 Many studies have investigated the prevention or treatment of DCI after SAH.…”

mentioning

confidence: 99%

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

Obata

Takeda

Sato

et al. 2016

JNS

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S ubarachnoid hemorrhage (SAH) from a ruptured aneurysm is accompanied by several complications, including electrolyte abnormalities, vasospasm, hydrocephalus, cardiac dysfunction, and pulmonary edema. 15,16,18 Among these complications, delayed cerebral ischemia (DCI) remains an important cause of morbidity and death. 15 Many studies have investigated the prevention or treatment of DCI after SAH.Triple-H therapy (i.e., hypertension, hypervolemia, and hemodilution) has reportedly been an effective approach abbreviatioNs CI = cardiac index; CRP = C-reactive protein; DCI = delayed cerebral ischemia; ELWI = extravascular lung water index; GEDI = global end-diastolic volume index; PVPI = pulmonary vascular permeability index; SAH = subarachnoid hemorrhage; SVRI = systemic vascular resistance index; WFNS = World Federation of Neurosurgical Societies. obJective Subarachnoid hemorrhage (SAH) is often accompanied by pulmonary complications, which may lead to poor outcomes and death. This study investigated the incidence and cause of pulmonary edema in patients with SAH by using hemodynamic monitoring with PiCCO-plus pulse contour analysis. methods A total of 204 patients with SAH were included in a multicenter prospective cohort study to investigate hemodynamic changes after surgical clipping or coil embolization of ruptured cerebral aneurysms by using a PiCCO-plus device. Changes in various hemodynamic parameters after SAH were analyzed statistically. results Fifty-two patients (25.5%) developed pulmonary edema. Patients with pulmonary edema (PE group) were significantly older than those without pulmonary edema (non-PE group) (p = 0.017). The mean extravascular lung water index was significantly higher in the PE group than in the non-PE group throughout the study period. The pulmonary vascular permeability index (PVPI) was significantly higher in the PE group than in the non-PE group on Day 6 (p = 0.029) and Day 10 (p = 0.011). The cardiac index of the PE group was significantly decreased biphasically on Days 2 and 10 compared with that of the non-PE group. In the early phase (Days 1-5 after SAH), the daily water balance of the PE group was slightly positive. In the delayed phase (Days 6-14 after SAH), the serum C-reactive protein level and the global end-diastolic volume index were significantly higher in the PE group than in the non-PE group, whereas the PVPI tended to be higher in the PE group. coNclusioNs Pulmonary edema that occurs in the early and delayed phases after SAH is caused by cardiac failure and inflammatory (i.e., noncardiogenic) conditions, respectively. Measurement of the extravascular lung water index, cardiac index, and PVPI by PiCCO-plus monitoring is useful for identifying pulmonary edema in patients with SAH.Clinical trial registration no.: UMIN000003794 (clinicaltrials.gov)http://thejns.org/doi/abs/10.3171/2015.6.JNS1519

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Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms

Cited by 69 publications

References 23 publications

Serum Cardiac Troponin T Levels as an Indicator of Myocardial Injury in Ischemic and Hemorrhagic Stroke Patients

Serum Cardiac Troponin T Levels as an Indicator of Myocardial Injury in Ischemic and Hemorrhagic Stroke Patients

ECG Changes in Subarachnoid Haemorrhage: A Synopsis

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

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