Document Detail

B-type natriuretic peptide release and left ventricular filling pressure assessed by echocardiographic study after subarachnoid hemorrhage: a prospective study in non-cardiac patients.
MedLine Citation:
PMID:  19454040     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Serum B-type natriuretic peptide (BNP) is frequently elevated after subarachnoid hemorrhage (SAH), but whether this high BNP level is related to transient elevation of left ventricular filling pressure (LVFP) is unknown. However, in patients with preexistent cardiac pathologies, it is impossible to differentiate between BNP elevation caused by chronic cardiac abnormalities and BNP related to acute neurocardiac injury.
METHODS: All adult patients with SAH admitted to our intensive care unit were eligible. Patients were excluded for the following reasons: admission >48 hours after aneurysm rupture, pre-existing hypertension, or cardiac disease. Levels of BNP and cardiac troponin Ic were measured daily for 7 days. Echocardiography was performed by a blinded cardiologist on days 1, 2, and 7. Doppler signals from the mitral inflow, tissue Doppler, and the color M-mode-derived flow propagation velocity (FPV) were obtained to assess echo-estimated LVFP.
RESULTS: During a 3-year period, sixty-six consecutive patients with SAH were admitted. Thirty one patients were studied. The BNP level was >100 ng/L in 25 patients (80%) during the first 3 days, with a peak on day 2 (median, 126 ng/L) followed by a gradual decrease (median variation days 1 to 7, 70%). All patients had an ejection fraction >50%. Early transmitral velocity/tissue Doppler mitral annular early diastolic velocity was low: 5.4 (+/- 1.5) on day 1, 5.8 (+/- 1.2) on day 2, and 5.1 (+/- 0.9) on day 7. Early transmitral velocity/FPV was also low: 1.27 (+/- 0.4), 1.25 (+/- 0.3), and 1.1 (+/- 0.2) on days 1, 2, and 7, respectively. Cardiac troponin Ic levels ranged from 0 to 3.67 microg/L and were correlated with BNP (r = 0.63, P < 0.01).
CONCLUSIONS: BNP rises gradually over two days and return to normal within a week after SAH. Its release is associated with myocardial necrosis, but is unrelated to elevated LVFP assessed by echocardiography.
Eric Meaudre; Christophe Jego; Nadia Kenane; Ambroise Montcriol; Henry Boret; Philippe Goutorbe; Gilbert Habib; Bruno Palmier
Publication Detail:
Type:  Journal Article     Date:  2009-05-20
Journal Detail:
Title:  Critical care (London, England)     Volume:  13     ISSN:  1466-609X     ISO Abbreviation:  Crit Care     Publication Date:  2009  
Date Detail:
Created Date:  2009-07-29     Completed Date:  2009-10-28     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  9801902     Medline TA:  Crit Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  R76     Citation Subset:  IM    
Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 - 83041 Cedex 9, France.
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MeSH Terms
Acute Disease
Cardiomyopathies / blood,  pathology
Echocardiography, Doppler
Natriuretic Peptide, Brain / blood*
Necrosis / blood
Prospective Studies
Subarachnoid Hemorrhage / blood*
Troponin I / blood
Ventricular Dysfunction, Left / blood*,  ultrasonography
Reg. No./Substance:
0/Troponin I; 114471-18-0/Natriuretic Peptide, Brain
Comment In:
Crit Care. 2009;13(4):163   [PMID:  19664172 ]

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