Prevalence and Characterization of ECG Abnormalities After Intracerebral Hemorrhage

Bree, Maurits D. R. van; Roos, Yvo B.W.E.M.; Bilt, Ivo A.C. van der; Wilde, Arthur A.M.; Sprengers, Marieke E.S.; Gans, Koen de; Vergouwen, Mervyn D.I.

doi:10.1007/s12028-009-9283-z

Cited by 69 publications

(36 citation statements)

References 32 publications

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“…ANP release is triggered by volume challenge of the cardiac atrium [20]. Alterations of ANP levels in hemorrhagic stroke patients seem to be multifactorial: cardiac abnormalities are common in patients with (severe) SAH and ICH [21,22,23,24]. …”

Section: Discussionmentioning

confidence: 99%

The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

et al. 2014

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Background: Atrial natriuretic peptide (ANP) is a well-known prognostic marker of outcome and mortality in patients with cardiovascular disease. Midregional proatrial natriuretic peptide (MR-proANP) is a stable fragment of the ANP precursor hormone. As a prognostic marker after ischemic stroke, it reliably predicts poststroke mortality and functional outcome. This study aimed to analyze the prognostic value of MR-proANP in patients with hemorrhagic stroke, i.e. subarachnoid (SAH) and intracerebral hemorrhage (ICH). Methods: MR-proANP was analyzed in patients with spontaneous SAH or spontaneous ICH. All patients were prospectively randomized into two treatment arms: (1) a prophylactic normothermia group with a target core temperature 36.5°C using endovascular cooling, and (2) a control group with conventional stepwise predefined fever management using antipyretic medication and surface cooling. Blood samples were obtained on admission and on days 4 and 7. Measurement of MR-proANP was performed in serum using sandwich immunoassay. The primary endpoint was functional outcome [assessed by the Glasgow Outcome Score (GOS)] and the secondary endpoints were mortality within 180 days after hemorrhagic stroke and influence of temperature on MR-proANP. A favorable outcome was defined as GOS 4-5, and the patients were considered to have a poor outcome with a 180-day GOS score between 1 and 3. Results: Analysis of MR-proANP was performed in 24 patients with spontaneous SAH and 22 patients with spontaneous ICH. MR-proANP was elevated on days 4 and 7 as compared to baseline levels (p < 0.05 and p < 0.001, respectively). High MR-proANP levels (>120 pmol/l) were associated with increased mortality and poor outcome (after 180 days; p < 0.05, respectively). There was no significant difference regarding MR-proANP serum concentrations between the endovascular and the control groups. Conclusions: Increased levels of MR-proANP are independently associated with poor functional outcome and increased mortality after 180 days in patients with hemorrhagic stroke. Endovascular temperature control had no significant influence on MR-proANP levels.

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Section: Discussionmentioning

confidence: 99%

The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

et al. 2014

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“…In patients with primary nontraumatic intracerebral hemorrhage (other than subarachnoid), QTc prolongation was the most frequently encountered abnormality (36%) followed by ST-T changes (23%) and T wave inversion (16%) (324). QTc prolongation was associated with insular involvement, but no other ECG attribute was associated with lesion location.…”

Section: Insular Stroke and Its Effect On Cardiac Repolarization And mentioning

confidence: 95%

The Insular Cortex and the Regulation of Cardiac Function

Oppenheimer

Cechetto

2016

Comprehensive Physiology

166

128

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Cortical representation of the heart challenges the orthodox view that cardiac regulation is confined to stereotyped, preprogrammed and rigid responses to exteroceptive or interoceptive environmental stimuli. The insula has been the region most studied in this regard; the results of clinical, experimental, and functional radiological studies show a complex interweave of activity with patterns dynamically varying regarding lateralization and antero-posterior distribution of responsive insular regions. Either acting alone or together with other cortical areas including the anterior cingulate, medial prefrontal, and orbito-frontal cortices as part of a concerted network, the insula can imbue perceptions with autonomic color providing emotional salience, and aiding in learning and behavioral decision choice. In these functions, cardiovascular input and the right anterior insula appear to play an important, if not pivotal role. At a more basic level, the insula gauges cardiovascular responses to exteroceptive and interoceptive stimuli, taking into account memory, cognitive, and reflexive constructs thereby ensuring appropriate survival responses and maintaining emotional and physiological homeostasis. When acquired derangements to the insula occur after stroke, during a seizure or from abnormal central processing of interoceptive or exteroceptive environmental cues as in psychiatric disorders, serious consequences can arise including cardiac electrophysiological, structural and contractile dysfunction and sudden cardiac death.

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“…10 It is well known that electrocardiographic abnormalities are common in patients with ischemic stroke, hemorrhagic stroke, and SAH. 8,11,12 Abnormalities on electrocardiogram that might lead to cardiac arrest such as QT prolongation are common in patients with stroke. 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.…”

Section: Vergouwen Et Al Complications After Clipped and Coiled Aneurmentioning

confidence: 99%

“…8,11,12 Abnormalities on electrocardiogram that might lead to cardiac arrest such as QT prolongation are common in patients with stroke. 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.…”

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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Prevalence and Characterization of ECG Abnormalities After Intracerebral Hemorrhage

Cited by 69 publications

References 32 publications

The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

The Insular Cortex and the Regulation of Cardiac Function

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

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