Document Detail


Use of the peak troponin value to differentiate myocardial infarction from reversible neurogenic left ventricular dysfunction associated with aneurysmal subarachnoid hemorrhage.
MedLine Citation:
PMID:  12650423     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Differentiating myocardial infarction (MI) from reversible neurogenic left ventricular dysfunction (stunned myocardium [SM]) associated with aneurysmal subarachnoid hemorrhage (SAH) is critical for early surgical intervention. The authors hypothesized that the cardiac troponin (cTn) trend and/or echocardiogram could be used to differentiate between the two entities. METHODS: A retrospective study was conducted for the period between 1995 and 2000. All patients included in the study met the following criteria: 1) no history of cardiac problems; 2) new onset of abnormal cardiac function (ejection fraction [EF] < 40% on echocardiograms); 3) serial cardiac markers (cTn and creatine kinase MB isoform [CK-MB]); 4) surgical intervention for their aneurysm; and 5) cardiac output monitoring either by repeated echocardiograms or invasive hemodynamic monitoring during the first 4 days post-SAH when the patients were euvolemic. Of the 350 patients with SAH, 10 (2.9%) had severe cardiac dysfunction. Of those 10, six were women and four were men. The patients' mean age was 53.5 years (range 29-75 years) and their SAH was classified as Hunt and Hess Grade III or IV. Aneurysm distribution was as follows: basilar artery tip (four); anterior communicating artery (two); middle cerebral artery (one); posterior communicating artery (two); and posterior inferior cerebellar artery (one). The mean EFonset was 33%. The changes on echocardiograms in these patients did not match the findings on electrocardiograms (EKGs). Within 4.5 days, dramatic improvement was seen in cardiac output (from 4.93 +/- 1.16 L/minute to 7.74 +/- 0.88 L/minute). Compared with historical controls in whom there were similar levels of left ventricular dysfunction after MI, there was no difference in peak CK-MB. A 10-fold difference, however, was noted in cTn values (0.22 +/- 0.25 ng/ml; control 2.8 ng/ml; p < 0.001). CONCLUSIONS: The authors determined the following: 1) that the CK-MB trend does not allow differentiation between SM and MI; 2) that echocardiograms revealing significant inconsistencies with EKGs are indicative of SM; and 3) that cTn values less than 2.8 ng/ml in patients with EFs less than 40% are consistent with SM.
Authors:
Ketan R Bulsara; Matthew J McGirt; Lawrence Liao; Alan T Villavicencio; Cecil Borel; Michael J Alexander; Allan H Friedman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  98     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-03-24     Completed Date:  2003-04-02     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  524-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA. krb1@acpub.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiac Output
Diagnosis, Differential
Echocardiography
Electrocardiography
Female
Humans
Intracranial Aneurysm / complications*
Male
Middle Aged
Myocardial Infarction / diagnosis*
Myocardial Stunning / blood,  diagnosis,  etiology
Retrospective Studies
Subarachnoid Hemorrhage / complications*,  etiology*
Time Factors
Troponin / blood*
Ventricular Dysfunction, Left / blood,  diagnosis*,  etiology*
Chemical
Reg. No./Substance:
0/Troponin

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


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