Critical Care Medicine

Adult Critical Care

Cardiac and central vascular functional alterations in the acute phase of aneurysmal subarachnoid hemorrhage

Papanikolaou J, Makris D, Karakitsos D, et al (Univ of Thessaly, Greece; General State Hosp of Athens, Greece; et al) Crit Care Med 40:223-232, 2012^§

Abstract

Objectives

To investigate aortic functional alterations in the acute phase of aneurysmal subarachnoid hemorrhage and to evaluate the relationship between potential cardiovascular alterations and delayed cerebral infarctions or poor Glasgow Outcome Scale score at discharge from critical care unit.

Design

Prospective observational study.

Setting

Critical Care Departments of two tertiary centers.

Patients

Thirty-seven patients with aneurysmal subarachnoid hemorrhage.

Interventions

Patients were evaluated at two time points: on admission (acute aneurysmal subarachnoid hemorrhage phase) and at least 21 days later (stable aneurysmal subarachnoid hemorrhage state). At baseline, the severity of aneurysmal subarachnoid hemorrhage was assessed clinically (Hunt and Hess scale) and radiologically (brain computed tomography Fisher grading). Aortic elasticity was evaluated by Doppler-derived pulse-wave velocity and left ventricular function by echocardiography. Serum B-type natriuretic peptide and troponin I were also assessed at the same time points.

Measurements and Main Results

At the acute phase, 23 patients (62%) were found to present supranormal pulse-wave velocity and 14 patients (38%) presented left ventricular systolic dysfunction; there were significant associations between pulse-wave velocity values and left ventricular ejection fraction (p < .001). Left ventricular ejection fraction and pulse-wave velocity were both associated with Hunt and Hess (p ≤ .004) and Fisher grading (p ≤ .03). Left ventricular ejection fraction and pulse-wave velocity were improved between acute aneurysmal subarachnoid hemorrhage and stable state (p ≤ .005); changes (Δ%) were greater in patients who initially had regional wall motion abnormalities compared to patients who had not (28.7% ± 10.2% vs. 2.4% ± 1.8% [p = .002] and −17.9% ± 3.7% vs. −3.5% ± 4.7% [p = .045], respectively). Pulse-wave velocity/left ventricular ejection fraction ratio was the only independent predictor for delayed cerebral infarctions. Left ventricular ejection fraction, B-type natriuretic peptide, pulse-wave velocity, and pulse-wave velocity/left ventricular ejection fraction showed significant diagnostic performance for predicting delayed cerebral infarctions or poor Glasgow Outcome Scale score (1–3).

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