- Poster presentation
- Open Access
Persistence of systemic and cerebral perfusion impairment in patients with neurocardiac injury after aneurysmal subarachnoid hemorrhage
© Hravnak et al.; 2015
- Published: 1 October 2015
- Cerebral Perfusion
- Cerebral Perfusion Pressure
- External Ventricular Drain
- Perfusion Parameter
- Aneurysm Rupture
Although it has been demonstrated previously that patients with aneurysmal subarachnoid hemorrhage (aSAH) who also experience neurocardiac injury have lower short term (0-3 days after aneurysm rupture) systemic and cerebral perfusion parameters compared to those without neurocardiac injury, it remains unknown if these changes persist over a longer time.
We aimed to determine if systemic and cerebral perfusion parameters across days 0-14 after SAH were persistently lower when cardiac troponin I (CTnI) was elevated (greater than or equal to 0.3 ng/ml [cTnI-High]) compared to when cTnI was nondetectable (less than 0.01 ng/ml [cTnI-ND]).
Longitudinal prospective analysis of 38 patients with aSAH. Inclusion: age 21-75 years, spontaneous aneurysm rupture, Fisher grade >1 and/or Hunt and Hess grade (HH) >2. Exclusion: traumatic SAH, recent myocardial dysfunction. Daily averages of systemic (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial blood pressure [MAP], heart rate [HR]) and cerebral (cerebral perfusion pressure [CPP]) perfusion parameters were used. Blood pressure was measured with arterial line, or if no arterial line then sphygmomanometer. Intracranial pressure (ICP) was measured using external ventricular drain and was used to calculate CPP (MAP-ICP). Mixed model linear regression was performed to test the difference in perfusion over time. Modeling was performed using the daily average for each perfusion parameter for each of days 0 to 14, and both without and with covariates (age, gender HH grade). The independent variable was daily average cTnI-High.
Elevated levels of cTnI are associated with lower systemic and cerebral perfusion parameters across fourteen days following aSAH. The driving force for the CPP direction was lower blood pressure and not higher ICP. Therefore, neurocardiac injury is associated with persistently lowered perfusion over time, not just within the first few days after aneurysm rupture. Further research is needed to determine if these persistently lower perfusion pressures translate into worse physical and neurocognitive function in the long term, and if more targeted perfusion support is needed for aSAH patients with neurocardiac injury during hospitalization.
NIH NINR R01NR014221
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.