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Analysis of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage with High Frequency Transcranial Duplex Ultrasound
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Analysis of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage with High Frequency Transcranial Duplex Ultrasound

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Predictors of left ventricular regional wall motion abnormalities after subarachnoid hemorrhage

Avinash Kothavale1, Nader M Banki, Alexander Kopelnik

  • 1Division of Cardiology, UCSF Medical Center, San Francisco, CA, USA.

Neurocritical Care
|June 8, 2006
PubMed

Insights

Regional wall motion abnormalities (RWMA) are common after subarachnoid hemorrhage (SAH). High Hunt & Hess grade, elevated cardiac troponin I (cTi), stimulant drug use, and tachycardia predict RWMA development.

Area of Science:

  • Cardiology
  • Neurology
  • Critical Care Medicine

Background:

  • Subarachnoid hemorrhage (SAH) can lead to cardiac abnormalities, including left ventricular (LV) systolic dysfunction, but the underlying mechanisms are unclear.
  • Previous reports indicate cardiac biomarker release and ECG changes following SAH.

Purpose of the Study:

  • To determine the prevalence of LV regional wall motion abnormalities (RWMA) after SAH.
  • To identify demographic and clinical predictors of RWMA development post-SAH.

Main Methods:

  • Prospective study of 300 patients with SAH, utilizing serial echocardiography.
  • Predictor variables included Hunt & Hess grade, age, gender, cardiac risk factors, aneurysm location, catecholamine levels, cardiac troponin I (cTi), heart rate (HR), blood pressure, and phenylephrine dose.
  • Multivariate logistic regression analysis was performed to identify independent predictors of RWMA.

Main Results:

  • RWMA were detected in 18% of the 300 patients studied (817 echocardiograms analyzed).
  • Prevalence of RWMA was higher in patients with Hunt & Hess grades 3-5 (35%) and elevated peak cTi levels >1.0 µg/L (65%).
  • Independent predictors of RWMA included high Hunt & Hess grade (OR 4.22), elevated cTi (OR 10.47), prior stimulant use (OR 5.50), and higher HR (OR 1.34 per 10 bpm increase).

Conclusions:

  • Regional wall motion abnormalities (RWMA) are frequent following subarachnoid hemorrhage (SAH).
  • High-grade SAH, elevated cardiac troponin I (cTi) levels, a history of stimulant drug use, and tachycardia are independent predictors of RWMA.
Abstract

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