Brain Natriuretic Peptide and Cerebral Vasospasm in Subarachnoid Hemorrhage

Sviri, Gil E.; Feinsod, Moshé; Soustiel, Jean F.

doi:10.1161/01.str.31.1.118

Cited by 87 publications

(39 citation statements)

References 34 publications

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“…Results from these studies indicated that it was the clinically apparent brain ischemia, rather than the angiographic or transcranial Doppler defined vasospasm, that was associated with the BNP increase. 13,19,20 This finding was later supported by Taub et al, 22 who showed in a larger study that high levels of BNP were associated with cerebral infarction detected on CT images. Brain natriuretic peptide has also been explored as a marker of cardiac injury in SAH patients, and high BNP at admission as well as high troponin-I on the 3rd day after admission has been found to be associated with increased inpatient deaths.…”

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confidence: 67%

“…Earlier studies have indicated that brain ischemia is associated with the increase of BNP. 13,19,20,22 Nakamura et al 15 described that BNP is higher in unconscious SAH patients than in awake patients. Brain ischemia appears several days after the bleeding as delayed ischemic neurological deficits, which could be associated with the BNP increase.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

Nyberg¹,

Karlsson

Ronne-Engström³

2014

JNS

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RuptuRe of an intracranial aneurysm is followed by an acute phase with a complex chain of events. Most obvious are the intracranial complications of clots, hydrocephalus, and brain ischemia in various degrees and combinations. Many patients also show serious systemic complications, probably as a result of the intracranial pathophysiology. It is generally thought that a main trigger for systemic changes is the increase in the intracranial pressure that occurs at the time of aneurysm rupture. The elevated intracranial pressure decreases cerebral blood flow and causes a transient or permanent global ischemia. A major stress reaction follows, including the release of adrenocorticotropic hormone, cortisol, Object. The rupture of an intracranial aneurysm is followed by increased intracranial pressure and decreased cerebral blood flow. A major systemic stress reaction follows, presumably to restore cerebral blood flow. However, this reaction can also cause adverse effects, including myocardial abnormalities, which are common and can be serious, and increased levels of natriuretic peptides, especially brain natriuretic peptide (BNP). The association of BNP with fluid and salt balance, vasospasm, brain ischemia, and cardiac injury has been studied but almost exclusively regarding events after admission. Brain natriuretic peptide has also been measured at various time points and analyzed in different ways statistically. The authors approached BNP measurement in a new way; they used the calculated area under the curve (AUC) for the first 4 days to quantitatively measure the BNP load during the first critical part of the disease state. Their rationale was a suspicion that early BNP load is a marker of the severity of the ictus and will influence the subsequent course of the disease by disturbing the fluid and salt balance.Methods. The study included 156 patients with acute spontaneous subarachnoid hemorrhage (SAH). Mean patient age was 59.8 ± 11.2 years, and 105 (67%) of the patients were female. An aneurysm was found in 138 patients. A total of 82 aneurysms were treated by endovascular coiling, 50 were treated by surgery, and 6 were untreated. At the time of admission, serum samples were collected for troponin-I analysis and for the N-terminal prohormone of BNP (NT-proBNP); daily thereafter, samples were collected for the NT-proBNP analysis. The cumulative BNP load was calculated as the AUC for NT-proBNP during the first 4 days. The following variables were studied in terms of their influence on the AUC for NT-proBNP: sex, age, World Federation of Neurosurgical Societies grade of SAH, Fisher grade, angiographic result, treatment of aneurysm, clinical neurological deterioration, verified infections, vasospasm treatment, and 6-month outcome.Results. The AUC for NT-proBNP was larger when variables indicated a more severe SAH. These variables were higher Fisher and World Federation of Neurosurgical Societies grades, high levels of troponin-I at admission, an aneurysm, neurological deficits, and infections. The AUC for NT-proBN...

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confidence: 67%

Section: Discussionmentioning

confidence: 99%

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

Nyberg¹,

Karlsson

Ronne-Engström³

2014

JNS

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“…The study was a prospective, single-centre, observational, cohort study of consecutive patients admitted to a general intensive care unit (ICU). All patients admitted to ICU during the study period were included, except those with severe neurological injury, because B-type natriuretic peptide levels are raised in brain injury [14][15][16].…”

Section: Methodsmentioning

confidence: 99%

B‐Type natriuretic peptide and the prediction of outcome in patients admitted to intensive care

et al. 2004

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SummaryB-type natriuretic peptide is known to predict outcome in congestive cardiac failure and myocardial infarction. We aimed to determine whether measurement of B-type natriuretic peptide would predict hospital mortality in patients admitted to an intensive care unit. We conducted a prospective observational cohort study in 78 consecutive patients. Demographics, clinical details and clinical outcomes were recorded. Admission and 24 h B-type natriuretic peptide and cardiac troponin I levels were measured. B-type natriuretic peptide and cardiac troponin I levels taken on intensive care admission and 24 h after admission did not accurately predict hospital mortality for all patients, including patients with severe sepsis or septic shock (all p > 0.05). B-type natriuretic peptide levels were higher in patients with severe sepsis and septic shock (p = 0.02), in patients ‡ 65 years (p = 0.04) and in patients with raised creatinine ‡ 110 lmol.l )1 (p = 0.02). We concluded that B-type natriuretic peptide, measured soon after admission to intensive care, does not usefully predict outcome after intensive care.

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“…In addition, it is a natriuretic, effective vasodilator factor and it is able to decrease the cerebral blood flow as a result of its systemic effects (16,20,21). This neurohormone is secreted as preproBNP and then divided as N-Terminal proBNP and BNP by being enzymatically disrupted due to the stretching of ventricular myocytes.…”

Section: Akgun B Et Al: the Correlation Of Serum Nt-probnp Levelsmentioning

confidence: 99%

The correlation of serum nt-probnp levels of hemorragic and ischemic lesions detected with diffusion MRI in head traumas

Akgun¹,

Erol²,

Yıldırım³

et al. 2012

Turkish Neurosurgery

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AIm:To evaluate the correlation between the dimensions of ischemic and hemorrhagic lesions detected by diffusion MRI and the changes in lesion dimensions with serum NT-proBNP levels in mild and moderate head trauma. mAterIAl and methOds: 30 patients were assessed in our study. A control group of 10 individuals with no trauma history was formed in order to establish normal serum NT-proBNP values. Patients underwent brain diffusion MRI 24 and 48 hours following admittance. Their plasma NT-proBNP levels were checked at the same stages. results:The correlation between the values of 24th and 48th hour Intra-axial hemorrhage (IAHEM) and Intra-axial ischemia (IAISC) and the values of 24th and 48th hour NT-proBNP was established as statistically significant. COnClusIOn:It was observed that the serum NT-proBNP values could be higher in patients with wide intra-axial lesion following head trauma than patients with smaller intra-axial lesions. In addition, the fact that it has been established that the serum NT-proBNP values of patients with increasing cerebral parenchymal lesion dimensions on the advancing hours after the trauma increase suggests that serum NTproBNP values may be significant in the follow-up of the dimensions of cerebral parenchymal damage. sOnuÇ: Serum NT-proBNP değerlerinin kafa travmaları sonrası intraaksiyal lezyonu geniş olan hastalarda daha küçük intraaksiyal lezyonlulardan yüksek olabileceği izlendi. Ayrıca travmanın ilerleyen saatlerinde serebral parankimal lezyon boyutları artan hastalarda serum NT-proBNP değerlerinin de artmasının belirlenmesi, serum NT-proBNP değerlerinin serebral parankimal hasarın boyutlarının takibinde önemli olabileceğini düşündürmektedir.

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Brain Natriuretic Peptide and Cerebral Vasospasm in Subarachnoid Hemorrhage

Cited by 87 publications

References 34 publications

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage

B‐Type natriuretic peptide and the prediction of outcome in patients admitted to intensive care

The correlation of serum nt-probnp levels of hemorragic and ischemic lesions detected with diffusion MRI in head traumas

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