Left Ventricular Dysfunction and Cerebral Infarction from Vasospasm After Subarachnoid Hemorrhage

被引:77
作者
Temes, Richard E. [1 ]
Tessitore, Elena [3 ]
Schmidt, J. Michael [1 ]
Naidech, Andrew M. [4 ]
Fernandez, Andres [1 ]
Ostapkovich, Noeleen D. [1 ]
Frontera, Jennifer A. [1 ]
Wartenberg, Katja E. [1 ]
Di Tullio, Marco R. [2 ]
Badjatia, Neeraj [1 ]
Connolly, E. Sander [1 ]
Mayer, Stephan A. [1 ,5 ]
Parra, Augusto [1 ,6 ]
机构
[1] Columbia Univ, Coll Phys & Surg, Neurol Intens Care Unit, New York, NY USA
[2] Columbia Univ, Coll Phys & Surg, Dept Cardiol, Div Med, New York, NY USA
[3] Albert Einstein Coll Med, Dept Internal Med, Bronx, NY 10467 USA
[4] Northwestern Univ, Sch Med, Dept Neurol, Chicago, IL 60611 USA
[5] Div Neurocrit Care, New York, NY 10032 USA
[6] Dept Neurosurg, San Antonio, TX 78229 USA
关键词
Subarachnoid hemorrhage; Cerebral infarction; Vasospasm; Neurogenic stunned myocardioum; Left ventricular dysfunction; Echocardiography; WALL-MOTION ABNORMALITIES; CARDIAC INJURY; MYOCARDIAL-INFARCTION; ARRHYTHMIAS; ISCHEMIA; STRESS; RISK;
D O I
10.1007/s12028-010-9447-x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Although neurogenic stunned myocardium (NSM) after aneurysmal subarachnoid hemorrhage (SAH) is well described, its clinical significance remains poorly defined. We investigated the influence of left ventricular (LV) dysfunction and cerebral vasospasm on cerebral infarction, serious cardiovascular events, and functional outcome after SAH. Of the 481 patients enrolled in the University Columbia SAH Outcomes Project between 10/96 and 05/02, we analyzed a subset of 119 patients with at least one echocardiogram, serial transcranial Doppler (TCD) data, and with no prior history of cardiac disease. LV dysfunction was defined as an ejection fraction < 40% on echocardiography. Infarction from vasospasm was adjudicated by the study team after comprehensive review of all clinical and imaging data. Functional outcome was assessed at 15 and 90 days with the modified Rankin Scale (mRS). Eleven percent of patients had LV dysfunction (N = 13). Younger age, hydrocephalus, and complete filling of the quadrigeminal and fourth ventricles were associated with LV dysfunction (all P < 0.05). Despite a similar frequency of pre-existing hypertension, 0% of patients with LV dysfunction reported taking antihypertensive medication, compared to 35% of those without (P = 0.009). There was a significant association between LV dysfunction and infarction from vasospasm after adjusting for clinical grade, age, and peak TCD flow velocity (P = 0.03). Patients with LV dysfunction also had higher rates of hypotension requiring vasopressors (P = 0.001) and pulmonary edema (P = 0.002). However, there was no association between LV dysfunction and outcome at 14 days after adjustment for established prognostic variables. LV dysfunction after SAH increases the risk of cerebral infarction from vasospasm, hypotension, and pulmonary edema, but with aggressive ICU support does not affect short-term survival or functional outcome. Antihypertensive medication may confer cardioprotection and reduce the risk of catecholamine-mediated injury after SAH.
引用
收藏
页码:359 / 365
页数:7
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