Document Detail


Clinical significance of elevated troponin I levels in patients with nontraumatic subarachnoid hemorrhage.
MedLine Citation:
PMID:  12691398     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Aneurysmal subarachnoid hemorrhage (SAH) is associated with electrocardiographic abnormalities, regional or focal wall-motion abnormalities on echocardiograms, and/or increased creatine kinase MB isoenzyme (CK-MB) or cardiac troponin I (cTnI). The goal of this prospective study was to compare the sensitivity and specificity of cTnI with those of CK-MB in the prediction of left ventricular dysfunction on echocardiograms in patients with nontraumatic SAH. In addition, those patients with abnormal findings on their echocardiograms and elevated cTnI levels were further evaluated for the presence of coronary artery disease (CAD) by a cardiologist and to determine whether any left ventricular dysfunction that had been detected was reversible. METHODS: The authors obtained electrocardiograms and echocardiograms, and measured serial levels of cardiac enzymes (CK-MB and cTnI) in 43 patients with nontraumatic SAH. Patients with known CAD were excluded. Those patients found to have elevated enzyme levels and abnormal findings on their echocardiograms underwent additional evaluation for CAD. The sensitivity and specificity of both cTnI and CK-MB for detecting left ventricular function were determined. Twenty-eight percent of patients with SAH in the study had elevated cTnI levels within the first 24 hours after hemorrhage. Seven of the 12 patients had evidence of left ventricular dysfunction on echocardiograms. In all these patients a return to baseline function was found during follow-up examinations. The authors found that cTnI is much more sensitive than CK-MB (100% compared with 29%) in the detection of left ventricular dysfunction in patients with SAH. CONCLUSIONS: An elevated level of cTnI is a good indicator of left ventricular dysfunction in patients with SAH. In this study cardiac dysfunction was reversible and should not necessarily preclude these patients from undergoing operative interventions or becoming heart donors. Clinical management may require more aggressive hemodynamic monitoring until cardiac function returns to normal.
Authors:
Ellen Deibert; Benico Barzilai; Alan C Braverman; Dorothy Farrar Edwards; Venkatesh Aiyagari; Ralph Dacey; Michael Diringer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  98     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-14     Completed Date:  2003-05-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  741-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurology, Washington University School of Medicine, St. Louis, Missouri 63108, USA. deiberte@neuro.wustl.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Biological Markers
Catecholamines / metabolism
Creatine Kinase / blood
Echocardiography
Electrocardiography
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood,  complications
Myoglobin / blood
Pulmonary Edema / diagnosis,  etiology
Sensitivity and Specificity
Severity of Illness Index
Subarachnoid Hemorrhage / blood*,  radiography
Tomography, X-Ray Computed
Tropomyosin / blood
Troponin I / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Catecholamines; 0/Myoglobin; 0/Tropomyosin; 0/Troponin I; EC 2.7.3.2/Creatine Kinase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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