Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage

Bilt, Ivo A.C. van der; Hasan, D.; Vandertop, W. Peter; Wilde, Arthur A.M.; Algra, Ale; Visser, Frans C.; Rinkel, Gabriël J.E.

doi:10.1212/01.wnl.0000342471.07290.07

Cited by 180 publications

(102 citation statements)

References 38 publications

(28 reference statements)

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“…An acute increase in troponin levels after SAH is a risk factor for cerebrovascular and cardiopulmonary complications (4). In a 253 patient SAH case series, serial troponin level measurements were performed and ECG controls were maintained to demonstrate the cardiac damage, and increased peak troponin levels were found to be related to left ventricular disfunction, pulmonary edema, hypotension in need of vasopressor support (as in our case), and increased cerebral ischemia related to vasospasm (10).…”

Section: Discussionsupporting

confidence: 51%

A Case of Cardiopulmonary Arrest with ST Elevation: What was the Main Cause?

Salçin¹,

Özen²,

Omercikoglu³

et al. 2015

JAEMCR

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Section: Discussionsupporting

confidence: 51%

A Case of Cardiopulmonary Arrest with ST Elevation: What was the Main Cause?

Salçin¹,

Özen²,

Omercikoglu³

et al. 2015

JAEMCR

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“…This finding is in line with those of earlier studies considering that measurements were taken on different days. 26,28 The fact that the serum NT-proBNP levels were highest after 3 days in patients with SAH and aneurysms argues, though, that the initial cardiac injury is not solely responsible for the increased levels. Other events during these days probably also play a role.…”

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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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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“…Patients with clipped aneurysms had a higher incidence of poor functional outcome at discharge (69.4% versus 51.4% of patients in clipped and coiled patients, respectively; PϽ0.0001) and mortality (at discharge: 14.6% versus 9.1% in clipped and coiled patients, respectively, Pϭ0.01; 30 days after SAH: 13 …”

Section: Comparison Of Outcome Parametersmentioning

confidence: 99%

“…8,11 A recent meta-analysis in patients with SAH showed that markers of cardiac damage and dysfunction are associated with poor outcome and mortality. 13 Damage to the insular cortex in patients with stroke has been associated with electrocardiographic abnormalities. 8 The results of our study have implications for daily practice.…”

Section: Vergouwen Et Al Complications After Clipped and Coiled Aneurmentioning

confidence: 99%

Higher Incidence of In-Hospital Complications in Patients With Clipped Versus Coiled Ruptured Intracranial Aneurysms

Vergouwen

Fang²,

Casaubon³

et al. 2011

Stroke

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on behalf of the Investigators of the Registry of the Canadian Stroke NetworkBackground and Purpose-After aneurysmal subarachnoid hemorrhage (SAH), patients with clipped aneurysms have a higher incidence of neurocognitive deficits and seizures compared with patients with coiled aneurysms. It remains unknown if patients with clipped aneurysms also have a higher incidence of other in-hospital complications. Methods-We used data from the Registry of the Canadian Stroke Network on consecutive patients admitted to hospital with aneurysmal SAH. Patients who died within 2 days after admission were excluded. Baseline characteristics, incidence of various in-hospital complications within 30 days after admission, length of stay, poor functional outcome (modified Rankin Scale score at discharge of Ն3), and mortality were compared between patients with clipped versus coiled aneurysms. Results-Of the 931 patients, 548 (59%) were clipped and 383 (41%) coiled. Baseline characteristics were similar.Compared with patients with coiled aneurysms, patients with clipped aneurysms had a higher incidence of in-hospital complications (

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Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage

Cited by 180 publications

References 38 publications

A Case of Cardiopulmonary Arrest with ST Elevation: What was the Main Cause?

A Case of Cardiopulmonary Arrest with ST Elevation: What was the Main Cause?

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

Higher Incidence of In-Hospital Complications in Patients With Clipped Versus Coiled Ruptured Intracranial Aneurysms

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