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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
Published on: August 30, 2020
Cardiovascular predictors of in-patient mortality after subarachnoid hemorrhage
Sirisha Yarlagadda1, Pam Rajendran, Jacob C Miss
1Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0124, USA.
Insights
Cardiovascular abnormalities, including elevated B-type natriuretic peptide and troponin I levels, predict mortality in subarachnoid hemorrhage (SAH) patients. These findings highlight the importance of cardiac monitoring after SAH.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality.
- The role of cardiac dysfunction in SAH outcomes remains debated.
- This study investigates cardiovascular abnormalities as predictors of mortality after SAH.
Purpose of the Study:
- To test the hypothesis that cardiovascular abnormalities are independently related to in-patient mortality after aneurysmal SAH.
- To identify specific cardiovascular markers associated with increased mortality risk.
Main Methods:
- Prospective cohort study of 300 patients with aneurysmal SAH.
- Serial measurements of heart rate, blood pressure, cardiac troponin I (cTi), B-type natriuretic peptide (BNP), and left ventricular ejection fraction.
- Multivariate logistic regression analysis to determine the association between cardiovascular variables and in-patient mortality.
Main Results:
- An initial BNP level > 600 pg/mL was strongly associated with death (OR 37.7).
- On day 3 post-SAH, elevated cTi (> 0.3 mg/L, OR 7.6), heart rate ≥ 100 bpm (OR 4.9), and low SBP (< 130 mmHg, OR 6.7) were significant predictors of mortality.
Conclusions:
- Cardiovascular abnormalities are independent predictors of in-patient mortality following SAH.
- Further research is needed to elucidate the causal mechanisms linking these abnormalities to SAH outcomes.
Background And Purpose:
Whether cardiac dysfunction contributes to morbidity and mortality after subarachnoid hemorrhage (SAH) remains controversial. The objective of this study was to test the hypothesis that cardiovascular abnormalities are independently related to in-patient mortality after SAH.
Methods:
This was a prospective cohort study of patients with aneurysmal SAH. Heart rate and blood pressure were measured, a blood sample was obtained, and echocardiography was performed on three study days, starting as soon after admission as possible. The cardiovascular predictor variables were heart rate, systolic blood pressure (SBP), cardiac troponin I (cTi) level, B-type natriuretic peptide (BNP) level, and left ventricular ejection fraction. The primary outcome measure was in-patient mortality. The association between each predictor variable and mortality was quantified by multivariate logistic regression, including relevant covariates and reporting odds ratios (OR) and 95% confidence intervals (CI).
Results:
The study included 300 patients. An initial BNP level greater than 600 pg/mL was markedly associated with death (OR 37.7, p < 0.001). On the third study day (9.1 +/- 4.1 days after SAH symptom onset), a cTi level greater than 0.3 mg/L (OR 7.6, p = 0.002), a heart rate of 100 bpm or greater (OR 4.9, p = 0.009), and a SBP less than 130 mmHg (OR 6.7, p = 0.007) were significantly associated with death.
Conclusions:
Cardiovascular abnormalities are independent predictors of in-patient mortality after SAH. Though these effects may be explained by a reduction in cerebral perfusion pressure or other mechanisms, further research is required to determine whether or not they are causal in nature.
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