Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemorrhage

Mayer, Stephan A.; Fink, Matthew E.; Homma, Shunichi; Sherman, David G.; Limandri, Giuseppe; Lennihan, Laura; Solomon, Robert A.; Klebanoff, Louise M.; Beckford, Avis; Raps, Eric C.

doi:10.1212/wnl.44.5.815

Cited by 197 publications

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“…Pulmonary edema worsens the prognosis of SAH and increases the mortality rate. 20 Therefore, preventing the development of pulmonary edema in patients with SAH is of utmost importance. In our study, the incidence of pulmonary edema in patients with SAH was 25%, and the rate was higher in older patients.…”

Section: Discussionmentioning

confidence: 99%

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

Obata

Takeda

Sato

et al. 2016

JNS

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S ubarachnoid hemorrhage (SAH) from a ruptured aneurysm is accompanied by several complications, including electrolyte abnormalities, vasospasm, hydrocephalus, cardiac dysfunction, and pulmonary edema. 15,16,18 Among these complications, delayed cerebral ischemia (DCI) remains an important cause of morbidity and death. 15 Many studies have investigated the prevention or treatment of DCI after SAH.Triple-H therapy (i.e., hypertension, hypervolemia, and hemodilution) has reportedly been an effective approach abbreviatioNs CI = cardiac index; CRP = C-reactive protein; DCI = delayed cerebral ischemia; ELWI = extravascular lung water index; GEDI = global end-diastolic volume index; PVPI = pulmonary vascular permeability index; SAH = subarachnoid hemorrhage; SVRI = systemic vascular resistance index; WFNS = World Federation of Neurosurgical Societies. obJective Subarachnoid hemorrhage (SAH) is often accompanied by pulmonary complications, which may lead to poor outcomes and death. This study investigated the incidence and cause of pulmonary edema in patients with SAH by using hemodynamic monitoring with PiCCO-plus pulse contour analysis. methods A total of 204 patients with SAH were included in a multicenter prospective cohort study to investigate hemodynamic changes after surgical clipping or coil embolization of ruptured cerebral aneurysms by using a PiCCO-plus device. Changes in various hemodynamic parameters after SAH were analyzed statistically. results Fifty-two patients (25.5%) developed pulmonary edema. Patients with pulmonary edema (PE group) were significantly older than those without pulmonary edema (non-PE group) (p = 0.017). The mean extravascular lung water index was significantly higher in the PE group than in the non-PE group throughout the study period. The pulmonary vascular permeability index (PVPI) was significantly higher in the PE group than in the non-PE group on Day 6 (p = 0.029) and Day 10 (p = 0.011). The cardiac index of the PE group was significantly decreased biphasically on Days 2 and 10 compared with that of the non-PE group. In the early phase (Days 1-5 after SAH), the daily water balance of the PE group was slightly positive. In the delayed phase (Days 6-14 after SAH), the serum C-reactive protein level and the global end-diastolic volume index were significantly higher in the PE group than in the non-PE group, whereas the PVPI tended to be higher in the PE group. coNclusioNs Pulmonary edema that occurs in the early and delayed phases after SAH is caused by cardiac failure and inflammatory (i.e., noncardiogenic) conditions, respectively. Measurement of the extravascular lung water index, cardiac index, and PVPI by PiCCO-plus monitoring is useful for identifying pulmonary edema in patients with SAH.Clinical trial registration no.: UMIN000003794 (clinicaltrials.gov)http://thejns.org/doi/abs/10.3171/2015.6.JNS1519

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Section: Discussionmentioning

confidence: 99%

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

Obata

Takeda

Sato

et al. 2016

JNS

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“…16) Although these two complications had been regarded as separate entities in the past, 18,35) recent studies indicate that they share a common pathophysiology and may coexist in the same patient. 12,20,21,24,31) The common pathophysiology involves massive catecholamine release, particularly norepinephrine, into the circulation immediately after aneurysm rupture, and is responsible for endothelial damage, vasoconstriction, and increased vascular permeability. 7,20,21) However, how often SAH patients complicated with NPE also have concomitant TCM (NPE-TCM) remains unclear, since evaluation of cardiac wall motion using transthorac-…”

Section: Introductionmentioning

confidence: 99%

“…In this study, the majority of patients sustained poor-grade (grade IV or V) SAH, whereas previous studies had smaller percentages of poor-grade SAH patients. 3,24) We made every effort to obtain CT angiography, and finally investigated 100% of grade IV and 84% of grade V patients. This study found a higher incidence of ECG abnormality (Table 1) compared with previous reports, in which ST segment change and QTc prolongation was observed in 46% and 31%, 21) but may be explained by the difference in disease severity.…”

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confidence: 99%

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

Inamasu

Nakatsukasa

Mayanagi

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Patients with poor-grade subarachnoid hemorrhage (SAH) are often complicated with acute cardiopulmonary dysfunctions, particularly neurogenic pulmonary edema (NPE) and takotsubo-like cardiomyopathy (TCM). This study retrospectively investigated the incidence, demographics, clinical characteristics, and outcomes of patients with SAH complicated with both NPE and TCM (NPE-TCM). The effects of aneurysm location and other clinical variables on the incidence of NPE-TCM were also investigated. Among 234 SAH patients treated during 5-year period, 16 (7%) presented with NPE, and transthoracic ultrasonography revealed that 14 of these 16 patients (88%) also had TCM. All 14 patients with NPE-TCM had poor-grade SAH (World Federation of Neurosurgical Societies grades IV and V). Ruptured posterior circulation aneurysm was predictive of NPE-TCM, but other clinical variables were not. Eight of the 14 patients with NPE-TCM could undergo treatment for ruptured aneurysm. Long-term outcomes were favorable in 5 of the 8 patients. Grade IV SAH patients had significantly better outcomes than grade V patients. TCM develops frequently in SAH patients presenting with NPE, and transthoracic ultrasonography should be conducted routinely in that population. Patients with ruptured posterior circulation aneurysm may have elevated risk of developing NPE-TCM. Endovascular obliteration of the aneurysm may be preferable to open surgery, but the optimal treatment modality needs to be evaluated further. Considering the limited number of SAH patients complicated with NPE-TCM, a multi-center cooperative study may be required.

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“…9) Such cases tend to be severe, and are often associated with pulmonary lung edema and hemodynamic instability. 10,12) Some cases may be ampulla (takotsubo) cardiomyopathy. The prognosis is usually good, but our case suggests that careful management of water balance and heart function is necessary.…”

Section: Discussionmentioning

confidence: 99%

Ampulla (Takotsubo) Cardiomyopathy Associated With Subarachnoid Hemorrhage Worsening in the Late Phase of Vasospasm-Case Report-

Ono

Kawamura

Ito

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 66-year-old woman presented with subarachnoid hemorrhage(SAH) caused by a ruptured aneurysm of the left middle cerebral artery. Electrocardiography (ECG) disclosed abnormalities resembling acute myocardial infarction. She underwent neck clipping of the aneurysm uneventfully. Sixteen days after admission, ECG again disclosed abnormalities resembling acute myocardial infarction, and echocardiography suggested heart failure. Coronary angiography showed no abnormalities, but left ventriculography showed severe hypokinesia in the apex of the heart consistent with so-called ampulla (takotsubo) cardiomyopathy. The heart failure was treated with catecholamines and her heart function gradually recovered. Ampulla (takotsubo) cardiomyopathy associated with SAH requires careful management of heart function.

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Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemorrhage

Cited by 197 publications

References 0 publications

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

Ampulla (Takotsubo) Cardiomyopathy Associated With Subarachnoid Hemorrhage Worsening in the Late Phase of Vasospasm-Case Report-

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