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Cardiac and central vascular functional alterations in the acute phase of aneurysmal subarachnoid hemorrhage.
MedLine Citation:
PMID:  21926590     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: To investigate aortic functional alterations in the acute phase of aneurysmal subarachnoid hemorrhage and to evaluate the relationship between potential cardiovascular alterations and delayed cerebral infarctions or poor Glasgow Outcome Scale score at discharge from critical care unit. DESIGN:: Prospective observational study. SETTING:: Critical Care Departments of two tertiary centers. PATIENTS:: Thirty-seven patients with aneurysmal subarachnoid hemorrhage. INTERVENTIONS:: Patients were evaluated at two time points: on admission (acute aneurysmal subarachnoid hemorrhage phase) and at least 21 days later (stable aneurysmal subarachnoid hemorrhage state). At baseline, the severity of aneurysmal subarachnoid hemorrhage was assessed clinically (Hunt and Hess scale) and radiologically (brain computed tomography Fisher grading). Aortic elasticity was evaluated by Doppler-derived pulse-wave velocity and left ventricular function by echocardiography. Serum B-type natriuretic peptide and troponin I were also assessed at the same time points. MEASUREMENTS AND MAIN RESULTS:: At the acute phase, 23 patients (62%) were found to present supranormal pulse-wave velocity and 14 patients (38%) presented left ventricular systolic dysfunction; there were significant associations between pulse-wave velocity values and left ventricular ejection fraction (p < .001). Left ventricular ejection factor and pulse-wave velocity were both associated with Hunt and Hess (p ≤ .004) and Fisher grading (p ≤ .03). Left ventricular ejection fraction and pulse-wave velocity were improved between acute aneurysmal subarachnoid hemorrhage and stable state (p ≤ .005); changes (Δ%) were greater in patients who initially had regional wall motion abnormalities compared to patients who had not (28.7% ± 10.2% vs. 2.4% ± 1.8% [p = .002] and -17.9% ± 3.7% vs. -3.5% ± 4.7% [p = .045], respectively). Pulse-wave velocity/left ventricular ejection fraction ratio was the only independent predictor for delayed cerebral infarctions. Left ventricular ejection fraction, B-type natriuretic peptide, pulse-wave velocity, and pulse-wave velocity/left ventricular ejection fraction showed significant diagnostic performance for predicting delayed cerebral infarctions or poor Glasgow Outcome Scale score (1-3). CONCLUSIONS:: Our findings suggest that significant cardiovascular alterations in left ventricular function and in aortic stiffness occur during the early phase of aneurysmal subarachnoid hemorrhage. These phenomena were associated with adverse outcomes in this study and their role in the pathogenesis of delayed neurologic complications warrants further investigation.
Authors:
John Papanikolaou; Demosthenes Makris; Dimitrios Karakitsos; Theodosios Saranteas; Andreas Karabinis; Georgia Kostopanagiotou; Epaminondas Zakynthinos
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-15
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Critical Care (JP, DM, EZ), School of Medicine, University of Thessaly, University Hospital of Larissa, Thessaly, Greece; Department of Critical Care (DK), General State Hospital of Athens, Athens, Greece; Second Department of Anaesthesiology (TS, GK), School of Medicine, University of Athens, University Hospital of Athens Attikon, Athens, Greece; Onassis Cardiac Surgery Center (AK), Athens, Greece.
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